House Republicans probe CVS for alleged HIPAA violation

https://www.healthcaredive.com/news/house-republicans-cvs-louisiana-lobbying-probe-hipaa/759427/

In June, CVS sent a mass text to pharmacy customers in Louisiana urging them to contact their representatives to oppose a PBM reform bill.

Dive Brief:

• Two Republican congressmen are investigating CVS over concerns that the company used confidential patient information to lobby against a Louisiana bill that would have forced it to break up its pharmacy business.
• On Thursday, House Oversight Committee Chair James Comer, R-Ky., and Federal Law Enforcement Subcommittee Chair Clay Higgins, R-La., sent a letter pressing CVS about its June text message campaign to patients, alleging it may have violated the HIPAA privacy law.
• The letter requests information about CVS’ use of patient data for the purposes of political advocacy in Louisiana and other states over the past five years. A spokesperson for CVS confirmed that the company has received the letter and plans to respond, while defending CVS’ behavior as “consistent with the law.” 

Dive Insight:

The letter stems from reports that on June 11 CVS sent a mass text message to thousands of customers in Louisiana using data that patients shared with the company for prescription drug services. The text threatened that local pharmacies would close and drug prices would rise if Louisiana were to pass H.B. 358, a bill that would prevent companies in the state from operating both pharmacy benefit managers and pharmacies.

The text urged recipients to contact their state representatives to oppose the bill, according to local reports.

CVS’ behavior appears to breach the HIPAA, the federal law protecting individuals’ personal health information, Comer and Higgins wrote in their letter to CVS CEO David Joyner.

“CVS Pharmacy routinely uses its mass text messaging system to notify patients about prescription updates and other individualized patient information,” the letter reads. “Therefore, it appears CVS Health’s use of protected patient information for the purposes of political advocacy may represent a violation of HIPAA.”

Louisiana’s attorney general Liz Murrill sent a cease-and-desist letter to CVS the day after the texts went out. CVS denied that its actions represented a violation of HIPAA to the state. Still, Louisiana filed an enforcement action against CVS in state court later that month, alleging that the text message campaign — and CVS’ ownership of both PBM Caremark and pharmacies — broke the state’s trade practices law.

CVS operates 119 pharmacies in Louisiana, along with one of the largest PBMs in the nation. That creates an inherent conflict of interest, according to critics of entrenched corporate power in the U.S. pharmaceutical supply chain.

It’s a concern shared by antitrust regulators. The Federal Trade Commission has issued two reports highly critical of PBMs, including of their ownership of pharmacies, and is suing Caremark and two other major PBMs for allegedly driving up the cost of insulin in the U.S.

Despite interest on the Hill, Congress has yet to pass legislation tackling PBM reform. States are stepping into the gap, including with legislation like that proposed by Louisiana. To date, Arkansas is the only state to actually pass a law preventing PBMs from owning or operating pharmacies, though a court paused implementation of the law in July.

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Pt’s statements in RED: My words are in Green

Remember she is doing speech to text

This disabled female pt reached out to me Aug 4th and her doc had just abruptly cut her oral opioids she had been taking for ~ 10yr from 90 MME/day to 30 MME/day and put a Buprenorphine patch on her the next day. This is just starting to evolve but I am going to leave this post at the top of the first page and update as things happen – STAY TUNE

This is Aug 5th:

My. Primary. Just upped my blood. Pressure meds he said. It could ending up having. A stroke    Could it be the patch. Causing my blood. Pressure. Going. Up. So. High

Is your doctor just an employee of a large hospital system. I would like to put a spot light on his employer – let me know

Now. I am. Super. Sick and Allie want. To. Do is. Sleep

Just took. My blood. Presdure229/117  I thought my daughter. Was. Going to. Have to. Call. A. Squad. For me. My right arm. Was killing me

I think it’s this medicine because as soon as this patch got into my system because it said it took two days my blood pressure went sky high because I had been at my oncologist and it was good. It was only one 10/90 and then as soon as I put this patch on that he prescribed it’s been Scott ever since.

They just keep up with my blood pressure medicine. It’s crazy.

If it doesn’t come down by Monday, I’m calling his office. I’m telling him I’ve taken off his patch.

Maybe my body cannot tolerate these patches

All. I want to do is. Sleep my. Head. Hurts. I can’t. Eat. Fill. Like. Freaking shit

It has my granddaughter. Freake. Out she keeps. Coming in my. Room. To check. On me

Cause like I laid on the couch after I got her from school at volleyball at 11:30 I did not wake up till 730. That is not like me. I’m very involved in all of their kids like grandkids sports and I missed a volleyball game and so she knows that’s not like a lady I see at McDonald’s today for my granddaughter. She said that I didn’t look very well and asked was I not feeling good I said my doctor trying to move medicines around.

Then they’ll probably say I’m a drug seeker that would be my luck

I just don’t understand my pain doctor. I personally feel he should’ve said well. I’m cutting you down. Let’s try one a month then the next month or two month then go to the tanks 321 but no he goes in and he I just walked in and he’s like I’m cutting you down and putting you on these patches

Thank. You

The cardiac. Lab. Can. Vouch too. They wanted to do a stress test but couldn’t because this is when my blood pressure started going up the cardiologist. He’s like we’re not even gonna try it. He’s like take the IV out. Send her home.

If I don’t. Strat. Doing better. By Tomorrow. I will go to Emergency

Maybe both how many other. Patients. Has. Done. It To. Beside. Me

If this is withdrawal, I don’t know how people can go through it like I personally feel like I’ve been hit by a Mack truck

I have been on 15 mg four times a day for 10 years at least

I have a broken back the knee replacement my shoulders won’t move. I have blown disc all through my spine, so I’m the hot mess express with pain things.

It came. Down to 170/110after I took. Patch off after 3. Hrs now going backup again

5 mg 2. Times a day

OK, I left right now. Definitely an eight.

It. Stayed. At 8

3. During the day. And. I took. One at bedtime

I. Did. When I. Was. On the. 15. It. Got me. To 5

And. My blood. Pressure Was. Never this. High

When I woke. Up. I took. It

They. Would last. Me. I. Go to bed. At 10 and wake up. Around 6. And I. Would need. It. Cause I would be. Hurting. So. Bad

When am moving around. It would. Wear. Off. In. 3 hrs

My. Dr. Is. One. Sided. He. Don’t. Listen. I have been on. 15. For. At least. 10 plus years

It just. Don’t make. Sense how. Are you. Going to do this. To. A. Person who. Is. Used. Yo. Taking. 15 mg 4times. A Day. To. 5 2. Times. A. Day I just. Can’t. Understand. It how. Many people. Has. He. Done. It 2

It would have made more sense if he had maybe taken one down then the next month take another down then the next one take it down again then cut me down to the five and I have been on these at least 10 years like I still feel like shit, headache unbelievable

Nauseated also

I understand he went to school for so many years I don’t want to lose his license cause he always talks about his children and his wife and sports But man, oh man, he’s really making me feel like shit

That’s what I thought. He should’ve started taping me down instead of A sudden

I am. Going to call. Him. Monday. I am. Sure. He. Won’t give a. Freak

What should I say to him?

That my blood pressure is off the chart. I have a headache. They couldn’t even do a stress test cause it’s so high. I feel like my skin is kind of crawling. I’m nauseated. I took off the patch cause I thought maybe that’s what was doing it.

Took. My blood. Presdure180/ 120

What kind of made more sense if he cut me down one a month or something like this is torture

Iwl. Before I go to bed

I. Just took the5. On. An empty stomach’s

205/90 my heart is. Beating. 90

Yes my. Daughter. Is. Very. Smart. With. Computer iwill. Ask. Her

I. Just. Want my headache. To. Stop

My blood. Pressure. Was 189/120. And my pulse was 110

8 at least

Aug 10, 2025, 9:44 AM

---

A day or two after she put the buprenorphine patch on she was scheduled to have a treadmill cardiac stress test. Before the test, they took her blood pressure and it was 240/120 – what the American heart Association claims is a hypertensive crisis level. This test was done in part of a hospital system. Of course the stress test was cancelled, and the staff just SENT HER HOME. Before she had the patch on, her blood pressure was more normalish. Here is the American Heart Association on its definition of blood pressure. You may have to click on the graphic TWICE to make it enlarge and more readable

09-09-2025 This pt and her story has fallen off my radar – but today she told me that they had cut her opioid from 15 mg QID to either 10 mg 1-2 X daily.  Her BP is ONLY 230/120.  Within 20 minute of taking a dose.. she starts feeling better and two hrs later, she appears to be going into some level of withdrawal again..  IMO… this suggests that she is a fast/ultra fast metabolizer. I have suggested that she get a pharmacogenomic DNA test (PGx) to determine her metabolism of opioids. Will the practitioners involved even believe in this test. I have found that some practitioners are still practicing with the knowledge they obtained during their time in college.

Aug 20,2025 Apparently this pt’s PCP is just started adding pharma blood pressure meds. The PCP tells her that her high BP – currently hanging in the 230/120 range and the pt is suffering from frequent nose bleeds is because she is in WITHDRAWAL .. I hate to tell her PCP (Medical Deity) that her journey to hell started about 5 weeks ago and for the most part her – since she is dependent – not addicted to opioids – her withdrawal should pretty much be over and her hypertensive crisis is caused by under/untreated pain.

Apparently her PCP is “smart enough” to diagnose that she is in withdrawal, but “not smart enough” to know how he could get her out of her hypertensive crisis. Maybe if he read her hospital notes when at one time they gave her enough opioids to manage her pain and her BP went down.

The PCP can only tell her that she needs to go back to her pain doc that wants to put a bupe patch back on her, which is the genesis of the path she has been on for almost 6 weeks.

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Back in pharmacy school, we were expected to memorize just about everything. Just one of our reference books. I don’t remember the title of the book but everyone referred to it as Goodman & Gilman – it was the size of a New York City phone book – medical students used the same book. The last semester, one professor told my class – all that stuff we made you memorize. It will eventually become useless – as medical science advanced, but we tried to make you GOOD RESEARCHERS… so that you will be able to know where to look up whatever new information that you will need.

I don’t read for “pleasure”, I read a lot for KNOWLEDGE! Years ago, – for some reason- I read some things about Pres Woodrow Wilson and a prohibition phase during almost exactly 100 yrs ago. Women fighting to get the right to vote, the alcohol prohibition and what I envisioned as our country trying to return to its puritanical roots. 

My mind starting seeing some images of 100 yrs ago and comparing to similar things that I am now seeing evolving over the last decade and now seemingly going forward at a “peddle to the metal” speed.

History may look back at this era in our history and Pres Trump may be viewed at a 21st century Woodrow Wilson. Except this time opioids and controlled meds and artificial ingredients in our foods will be the “new devil”

I am concerned that no one will try to discover if there is a link in our environment that has caused so many of us to be suffering from chronic pain. I think that “they” are focused on so many other disease issues that the estimated 100 million chronic pain pts will be overlooked, and continue to be denied pain management.

The early 20th-century Prohibition movement can indeed be seen as a return to—or at least a revival of—America’s Puritanical roots in its approach to morality, community responsibility, and social reform. The Puritan settlers of New England espoused not only religious beliefs but a worldview that emphasized discipline, community responsibility for moral conduct, and the use of law as an instrument of social order and moral uplift.

Puritan Influence on Prohibition

• The temperance and Prohibition movements drew heavily on Puritan values such as sobriety, self-restraint, and a mandate to reform both self and society for the collective good.

• Religious revivals of the late 19th and early 20th centuries (rooted in Protestant evangelicalism with strong Puritan antecedents) shaped temperance as a moral crusade, equating alcohol consumption with sin and social decay.

• Prohibition-era propaganda and activism often invoked communal salvation and moral mission, both themes deeply embedded in Puritan ideology.

• The movement sought to use law to enforce personal and collective morality, mirroring the Puritan idea that societal well-being depended on rooting out individual vice.

Early 20th Century: Progressive and Puritanical

• The early 20th century Progressive Era in America combined a drive for social improvement (like child labor reform and women’s suffrage) with a moralizing, occasionally coercive, approach to perceived vice such as alcohol consumption.

• Prohibition’s leaders often saw their campaign as a way to create a virtuous, orderly society—a modern echo of the Puritan pursuit of a “city upon a hill”.

• This era saw other “Puritan-style” reforms, such as “blue laws” restricting Sunday activities, again reflecting an impulse to legislate morality.

In summary, the Prohibition movement was a direct descendant of the Puritan tradition, filtering its religious and communal ethos into a national policy intended to shape personal behavior and uplift society as a whole.

The United States underwent a formal prohibition phase between 1920 and 1933, but this occurred after the Taft administration and was largely implemented during the presidencies of Woodrow Wilson, Warren Harding, Calvin Coolidge, and Herbert Hoover. Prohibition was established nationwide by the Eighteenth Amendment ratified in 1919 and enforced by the Volstead Act, which banned the production, transportation, and sale of alcoholic beverages. William Howard Taft, serving as president from 1909 to 1913, opposed Prohibition before its passage but later, as Chief Justice, supported strict enforcement of anti-liquor laws.

Timeline of US Prohibition

• Taft Presidency (1909–1913): Prohibition was not national law, though temperance and local bans were common. Taft himself did not promote prohibition as president.

• Prohibition Era (1920–1933): Nationwide ban via the 18th Amendment and Volstead Act, leading to widespread illegal alcohol production and organized crime until repeal in 1933 through the 21st Amendment.

Modern Prohibition-like Movements

There is growing discussion about a “neo-prohibition” trend in the US, particularly stricter regulations and public health campaigns centered around alcohol and other substances. Recent calls for warning labels on alcoholic beverages and renewed advocacy for temperance suggest echoes of the earlier movement, though there is no formal or constitutional prohibition as seen in the early 20th century. Various states and federal initiatives regulate substances like tobacco, cannabis, and vaping, with some activists pushing stricter controls, but these do not amount to a sweeping, constitutional prohibition like the 1920s.

There is no sign of a true constitutional prohibition in contemporary America, but increased regulation and debates over alcohol and substance use do echo aspects of the early 20th-century movement.

There are strong signs that the United States is edging toward a new era of prohibition-like restrictions—particularly regarding opioid pain management, new opioid derivatives, and access to controlled medications.

7-OH and Kratom Regulation

Recently, the FDA has called for the classification of 7-hydroxymitragynine (7-OH), a compound derived from kratom (a member of the coffee family), as a Schedule I controlled substance. This compound is a potent mu-opioid receptor agonist and, according to research, is multiple times stronger than morphine in both pain relief and respiratory depression. If reclassified as Schedule I, it would be placed alongside substances like heroin—declared as having “no currently accepted medical use” and a “high potential for abuse,” which also means clinical research to evaluate therapeutic value is effectively blocked. The FDA’s rationale is the public health threat presented by increasingly concentrated 7-OH products sold in gas stations and smoke shops nationwide.

Opioid Production Quotas and Pharmacy Access

Since around 2015, the DEA has been aggressively cutting production quotas for key opioids, attempting to curb over-prescription that fueled the opioid epidemic. This quota reduction led to drug shortages, directly impacting pain patients and making it increasingly difficult for community pharmacies to secure sufficient stock to serve legitimate patient needs, particularly those with chronic pain. Litigation and settlements with drug wholesalers (McKesson, Cardinal, AmerisourceBergen) as well as manufacturers led to agreements for these entities to further restrict the quantity of opioids shipped to pharmacies, with centralized monitoring of “suspicious orders” and other stringent anti-diversion measures.

Impact on Chronic Pain Patients

The combined result: less than 2% of an estimated 100 million Americans with chronic pain currently receive opioid pain management, even though some have well-documented medical need. Pharmacies, caught between regulatory quotas and anti-diversion settlements, report systemic difficulties keeping adequate supplies of opioids, sometimes being forced to ration medicine for patients with cancer, palliative, or severe chronic conditions.

Are We Entering a New Prohibition Era?

The regulatory climate—a rapid move to Schedule I for promising pain-relief compounds like 7-OH, drastically reduced opioid quotas, and aggressive legal settlements restricting controlled medication access—strongly resembles the early 20th century’s prohibitionist mentality. The focus is now on containment, restriction, and public health optics, not on expanding therapeutic options, research, or nuanced clinical care. While not a literal nationwide constitutional prohibition like the 1920s alcohol ban, the functional effect is that vulnerable groups—chronic pain patients included—face barriers that parallel prohibition’s social consequences: black market emergence, untreated suffering, and loss of medical autonomy.

Summary Table: Current Climate vs. Historical Prohibition

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I ran across this on the web, I don’t know who is speaking and/or what group is at this meeting. You can just the video for yourself!

David Martin PhD, CEO and chairman of Mosaic Collateral Asset Management aka M·CAM, is the man speaking if anyone is interested.

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About HALF of the <D> in the House voted either against or “present” on this bill. I guess that there is no issue so benign that some in the House can agree upon ?

Congressional Action

The House passed the resolution with a bipartisan vote on September 19, 2025.

Vote breakdown: 310 in favor, 58 opposed, and 38 present. 95 Democrats joined 215 Republicans to support the measure.
Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent

Democrats Who Voted “No” (Partial List)

Notable Democrats who voted against the resolution include:

• Alexandria Ocasio-Cortez (NY)

• Ilhan Omar (MN)

• Ayanna Pressley (MA)

• Pramila Jayapal (WA)

• Jasmine Crockett (TX)

• Raja Krishnamoorthi (IL)

• Lucy McBath (GA)

• Gwen Moore (WI)

• Rashida Tlaib (MI)

• Lauren Underwood (IL)

• Nydia Velázquez (NY)

• Maxine Waters (CA)

• Bonnie Watson Coleman (NJ)

• Nikema Williams (GA)

• Frederica Wilson (FL)

Democrats Who Voted “Present” (Partial List)

Prominent “present” votes include:

• Alma Adams (NC)

• Don Beyer (VA)

• Suzanne Bonamici (OR)

• Julia Brownley (CA)

• Salud Carbajal (CA)

• Greg Casar (TX)

• Diana DeGette (CO)

• Mark DeSaulnier (CA)

• Maxine Dexter (OR)

• Lois Frankel (FL)

• Ro Khanna (CA)

• Doris Matsui (CA)

• Chellie Pingree (ME)

• Mark Pocan (WI)

• Linda Sánchez (FL)

• Paul Tonko (NY)

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Ever couple of days, I may ask perplexity.ai a questions about something and he/she/it will come back with a answer that I believe is mostly from the HEADLINES of the FAKE NEWS.

So I typically ask questions that challenges the answer given and “it” is forced to defend the original answer and typically will get a little “deeper in the weeds”

This particular interaction was rather short, compared to other similar interactions with “it”.

However, the very last short summary paragraph, tells the real bottom line of what the DOJ/DEA agenda and processes really are. To keep up how/why they justify their agenda of reduce the amount of Rx opioids are available.

I have put my questions to perplexity.ai in GREEN TEXT and I have drawn a horizontal line

at the end of the answer of a question.

Feel free to use this, when/if you talk to bureaucrats/politicians as to why your pharmacy does not have the medication(s) that your physician has deemed appropriate to help you manage your pain or other diagnosed medical issues.

I believe that it has been stated that the vast majority of the 100,000/yr opioid poisoning/OD was from illegal Fentanyl acetate from the Mex cartels and not the FDA approved Fentanyl citrate analog used in by practitioners. Would that not suggest that legal Rx Fentanyl is not a major contributor of synthetic opioid poisoning/OD

The data overwhelmingly support that the majority of the more than 100,000 annual opioid poisoning and overdose deaths in the U.S. are now due to illicitly manufactured fentanyl—primarily trafficked by Mexican cartels—rather than the FDA-approved fentanyl formulations used correctly in medical settings. This distinction is widely recognized by federal agencies, researchers, and harm reduction specialists.[1][2][3]

### Illicit Fentanyl: The Primary Driver
– DEA and CDC reports confirm that synthetic opioids, particularly illicit fentanyl analogs produced and distributed by criminal organizations, account for most fatal opioid overdoses in recent years.[2][3][1]
– The U.S. National Drug Threat Assessment and multiple DEA alerts specifically highlight the role of Mexican drug cartels (especially Sinaloa and CJNG) in producing the vast quantities of illicit fentanyl found in counterfeit pills and powders on the streets.[3][4][1]
– Prescription fentanyl—FDA-approved fentanyl citrate, properly prescribed—is rarely implicated in overdose spikes.[2]

### Limited Role of Prescription Fentanyl
– NIDA and CDC data show that while prescribed fentanyl can be misused, its contribution to national overdose statistics is vastly outweighed by illicit fentanyl.[5][6][2]
– Most overdose victims did not intend to take fentanyl: they used other drugs (like heroin or counterfeit pills) adulterated with fentanyl, unknown to them.[7][8]

### Conclusion
These facts strongly indicate that legal, prescribed fentanyl is not the major driver of synthetic opioid overdoses or poisoning deaths currently—the crisis is fueled by illicit sources, not by U.S. pharmaceutical supply chains.[4][1][3][5][2]

[1](https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine)
[2](https://nida.nih.gov/research-topics/fentanyl)
[3](https://www.dea.gov/sites/default/files/2025-07/2025NationalDrugThreatAssessment.pdf)
[4](https://www.dea.gov/sites/default/files/2024-05/NDTA_2024.pdf)
[5](https://www.psychiatry.org/patients-families/opioid-use-disorder)
[6](https://www.osc.ny.gov/reports/continuing-crisis-drug-overdose-deaths-new-york)
[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC8154745/)
[8](https://www.dea.gov/alert/dea-laboratory-testing-reveals-6-out-10-fentanyl-laced-fake-prescription-pills-now-contain)
[9](https://www.congress.gov/crs-product/IF10400)
[10](https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html)
[11](https://www.oregon.gov/oha/ph/preventionwellness/substanceuse/opioids/pages/fentanylfacts.aspx)
[12](https://www.socialworkers.org/Practice/Behavioral-Health/Behavioral-Health-Tools/The-Impact-of-Fentanyl-on-the-Opioid-Crisis-and-Role-of-Social-Workers)
[13](https://www.who.int/news-room/fact-sheets/detail/opioid-overdose)
[14](https://www.yalemedicine.org/news/fentanyl-driving-overdoses)
[15](https://www.sciencedirect.com/science/article/pii/S2772724623000203)
[16](https://www.ncbi.nlm.nih.gov/books/NBK458653/)
[17](https://www.countyhealthrankings.org/health-data/community-conditions/health-infrastructure/health-promotion-and-harm-reduction/drug-overdose-deaths)
[18](https://www.dea.gov)
[19](https://journalofethics.ama-assn.org/article/how-fda-failures-contributed-opioid-crisis/2020-08)
[20](https://www.ice.gov/features/opioid-crisis)

With these facts, can you explain the DOJ/DEA agenda to continue to reduce the number of the FDA approved Fentanyl citrate for treating chronic pt pain

The DEA and DOJ’s continued effort to reduce the quota for FDA-approved fentanyl citrate, even as overdose deaths are overwhelmingly driven by illicit fentanyl, reflects multiple intertwined policy objectives—though these measures are increasingly criticized by pain and palliative care experts for their unintended impact on patients with legitimate medical need. The official rationale for opioid quota reductions centers on controlling diversion risk and responding to perceived public health demands, but there is a significant disconnect between evidence of diversion from medical sources and actual overdose trends.[1][2][3]

### Official Policy Reasons for Quota Reduction
– DEA sets annual opioid quotas using various data sources, such as legitimate medical need, inventory trends, and requests from FDA and manufacturers.[4][1]
– DEA and DOJ believe controlling the supply of scheduled opioids—including fentanyl—limits opportunities for diversion and supports broader goals of reducing opioid-related morbidity and mortality.[5][4][1]
– This approach emerged in the earlier phases of the opioid crisis, when prescriptions from healthcare providers played a larger role in opioid mortality.[4][5]

### Current Critiques and Disconnect
– Most overdose deaths now involve illicit fentanyl from sources outside the medical supply chain, mainly Mexican and Chinese cartels.[2][6][7]
– Significant quota reductions have led to drug shortages for chronic pain, cancer, and palliative care patients, often leaving them unable to fill essential prescriptions.[3][2]
– Medical associations, patient advocates, and some regulators argue that quotas and prescription supply restrictions do not address the root of today’s overdose crisis and instead create avoidable suffering for those with legitimate clinical needs.[2][3]
– While DEA periodically claims these policies are meant to balance diversion risk and legitimate need, critics contend that the policies lack scientific basis for reducing diversion and inadvertently punish vulnerable pain patients.[3][2]

### Conclusion
The DOJ/DEA agenda to continue reducing prescription fentanyl production is a continuation of supply-side strategies developed in response to earlier prescription-driven opioid crises, now misapplied in a landscape where most fatalities result from illicit fentanyl totally outside the U.S. pharmaceutical system.[6][7][1][2][3]

[1](https://www.deadiversion.usdoj.gov/quotas/12-17-2024-Final-Established-APQ-for-2025-005.pdf)
[2](https://www.statnews.com/2024/12/27/opioid-medication-production-quotas-dea-pain-patients/)
[3](https://pmc.ncbi.nlm.nih.gov/articles/PMC7585510/)
[4](https://www.dea.gov/press-releases/2018/08/16/justice-department-dea-propose-significant-opioid-manufacturing-reduction)
[5](https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_Web-DIR-007-20_2019.pdf)
[6](https://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf)
[7](https://www.dea.gov/sites/default/files/2025-07/2025NationalDrugThreatAssessment.pdf)
[8](https://www.justice.gov/archives/opa/press-release/file/1079531/dl?inline=)
[9](https://www.federalregister.gov/documents/2022/12/02/2022-26351/established-aggregate-production-quotas-for-schedule-i-and-ii-controlled-substances-and-assessment)
[10](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/019115s042lbl.pdf)
[11](https://www.usfa.fema.gov/blog/drug-enforcement-administration-2024-national-drug-threat-assessment/)
[12](https://www.dea.gov/documents/2025/2025-05/2025-05-13/national-drug-threat-assessment)
[13](https://www.regulations.gov/document/DEA-2025-0078-0001)
[14](https://www.dea.gov/resources/facts-about-fentanyl)
[15](https://www.justice.gov/archives/opa/pr/department-justice-announces-results-enforcement-surge-reduce-fentanyl-supply-across-united)
[16](https://www.federalregister.gov/documents/2024/01/03/2023-28962/established-aggregate-production-quotas-for-schedule-i-and-ii-controlled-substances-and-assessment)
[17](https://www.asahq.org/advocacy-and-asapac/fda-and-washington-alerts/washington-alerts/2020/04/asa-urges-federal-government-to-take-action-on-drug-shortages)
[18](https://www.ncbi.nlm.nih.gov/books/NBK537318/)
[19](https://www.dea.gov/documents/2024/2024-05/2024-05-24/national-drug-threat-assessment-2024)
[20](https://www.federalregister.gov/documents/2023/08/31/2023-18885/management-of-quotas-for-controlled-substances-and-list-i-chemicals)

With estimates that <2% of chronic pain pts are getting “some” opioid pain management – not adequate pain management. Is the DEA using misinformation that stating that people are dying from “Fentanyl” not illicit Fentanyl to allow them to “support” the agenda that they have used for decades

The DEA does not consistently differentiate between prescription fentanyl and illicit fentanyl in its public messaging, which can lead to public confusion and policy support for further restricting opioid access—even though nearly all deaths are traced to illicitly manufactured fentanyl from drug traffickers. This lack of clarity—and broad use of the term “fentanyl” without specifying the source—does help maintain public fear regarding prescription opioids, indirectly supporting policies that further reduce opioid pain management options for chronic pain patients.[1][2][3][4][5][6]

### Patient Access and Misinformation
– Recent expert analyses and patient surveys estimate that fewer than 2% of chronic pain patients currently receive even minimal opioid therapy, often inadequate for real pain control due to regulatory supply restrictions.[7][6]
– DEA messaging on overdose deaths frequently uses the term “fentanyl” to encompass both prescription and illegally manufactured versions, even as agency alerts and testing show the overwhelming majority of deaths result from illicit sources—primarily counterfeit pills and adulterated street drugs, not legitimate prescriptions.[8][2][4][1]
– By failing to clarify this distinction, DEA policy rhetoric enables continued limitation of prescription fentanyl quotas and supports aggressive enforcement on clinicians—even though the real crisis is not being driven by medical prescribing.[5][6]

### Policy Impact
– These supply-side restrictions—reinforced by conflated messaging—leave many pain patients under treated or untreated, despite essentially no evidence linking prescription opioid use for pain to current overdose statistics.[6][5][7]
– Critics, including medical associations, argue that such misinformation allows the DEA to justify maintaining policies from an earlier opioid crisis era, even as the real threat is now almost exclusively illicit.[5][7][6]

In summary, by not explicitly distinguishing between deaths from illegal and prescription fentanyl, the DEA sustains public and policy support for limiting access to vital pain management, despite the facts showing prescription access is not the driver of current overdose deaths.[2][4][7][6][5]

[1](https://www.dea.gov/resources/facts-about-fentanyl)
[2](https://www.dea.gov/alert/dea-laboratory-testing-reveals-6-out-10-fentanyl-laced-fake-prescription-pills-now-contain)
[3](https://www.oregon.gov/oha/ph/preventionwellness/substanceuse/opioids/pages/fentanylfacts.aspx)
[4](https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine)
[5](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm)
[6](https://www.statnews.com/2024/12/27/opioid-medication-production-quotas-dea-pain-patients/)
[7](https://www.sciencedirect.com/science/article/pii/S1526590020300900)
[8](https://www.dea.gov/press-releases/2024/11/15/deas-third-annual-national-family-summit-fentanyl-highlights-progress)
[9](https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates)
[10](https://www.neurology.org/doi/10.1212/WNL.0000000000000839)
[11](https://www.dea.gov/resources/documents?f%5B0%5D=document_type%3A2431&f%5B1%5D=document_type%3A3141&f%5B2%5D=drug_categories%3A326&f%5B3%5D=drug_categories%3A331&f%5B4%5D=drug_categories%3A336&f%5B5%5D=drug_categories%3A441&f%5B6%5D=drug_categories%3A606&f%5B7%5D=drug_categories%3A646&f%5B8%5D=drug_categories%3A691&f%5B9%5D=drug_categories%3A3356&f%5B10%5D=drug_categories%3A3426&f%5B11%5D=publication_type%3A2586&f%5B12%5D=publication_type%3A2596&f%5B13%5D=publication_type%3A2601&f%5B14%5D=publication_type%3A3121&f%5B15%5D=publication_type%3A3366&field_document_document_type_value=Publication&page=1)
[12](https://www.ncbi.nlm.nih.gov/books/NBK537318/)
[13](https://www.governor.virginia.gov/newsroom/news-releases/2025/april/name-1045381-en.html)
[14](https://www.ncbi.nlm.nih.gov/books/NBK458653/)
[15](https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-serious-risks-and-death-when-combining-opioid-pain-or)
[16](https://www.cuanschutz.edu/chancellor/messages/communiques/addressing-the-fentanyl-crisi)
[17](https://www.psychiatry.org/patients-families/opioid-use-disorder)
[18](https://www.cdc.gov/mmwr/volumes/71/wr/mm7150a2.htm)
[19](https://www.socialworkers.org/Practice/Behavioral-Health/Behavioral-Health-Tools/The-Impact-of-Fentanyl-on-the-Opioid-Crisis-and-Role-of-Social-Workers)
[20](https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html)
[21](https://www.tn.gov/content/dam/tn/health/healthprofboards/pain-management-clinic/ChronicPainGuidelines.pdf)

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Stop Medicare scams before they stop you

https://cyberguy.com/scams/stop-medicare-scams-before-they-stop-you/

Medicare is a tempting prize for scammers. Because it’s a public program funded by taxpayers, it has a huge budget to distribute, and that’s what attracts scammers. In 2024, improper payments added up to $54 billion. Some scams involve setting up fake companies to file bogus claims, while others target beneficiaries directly, stealing their personal information and denying them their right to treatment.

If you fall victim to such a scam, the consequences can range from small financial losses to actual health risks. Scammers may trick you into paying fake fees, premiums, or “copays” over the phone or online. They may also go after your personal information or Medicare number to bill for services or equipment you never requested, which could leave you with less coverage when you actually need treatment.

It’s better to know what you’re up against so you don’t accidentally lose your Medicare benefits.

What to look out for to recognize a Medicare scam

Scammers are getting more and more professional these days. With Medicare scams, fraudsters may use spoofed phone numbers, emails, and websites to make their schemes seem more believable. Luckily, there are still some telltale signs to look out for.

Regardless of the communication method, phone, email, mail, or in person, scammers will try to:

• Create fear or urgency
• Pressure you to act quickly
• Threaten you with consequences

Scammers calling you in Medicare’s name to demand payments

Some scammers use spoofed phone numbers to impersonate Medicare representatives. They may try to trick you into paying fake fees or buying unnecessary products.

These often include:

• Fake health insurance upgrades
• “Low-cost” medical equipment
• Fake tests or genetic kits
• Discounted medication

Remember: Medicare will never call you unless you ask them to, and they will never ask for money.

If you ever owe Medicare fees, you will be contacted by mail, not by phone. Furthermore, Medicare insurance itself is free, and you will never be asked to pay fees just to keep it active.

You may only be required to pay in certain circumstances, such as a portion of the cost for a treatment or prescription drugs, but these bills will always be sent to you by mail, never via phone calls or online forms.

Scammers try to mimic these payments to steal your money

Scammers may try calling you in Medicare’s name to ask for your Medicare number or card details.

Money isn’t the only thing scammers are after; your Medicare number can be just as valuable, if not more so.

This scam follows a similar scheme: fraudsters call you pretending to be Medicare employees and ask you to provide your Medicare number for fake reasons, such as:

• Upgrading your plan
• Updating your account details
• Offering “free” drugs
• Issuing a new Medicare card
• …and more

Let me be clear: Medicare will never call you, whether it’s about paying fees, updating your account, or anything else.

Scammers want your Medicare information so they can impersonate you and obtain medical supplies, prescription drugs, or treatments in your name.

Scammers calling you in Medicare’s name to extort your personal data

Your Social Security number (SSN) can be the final piece scammers need to impersonate you. During these calls, fraudsters may ask not only for your Medicare details but also for other personal information, such as your SSN, date of birth, or similar data.

They often use the same excuses as when trying to obtain Medicare information, such as:

• Upgrading your plan
• Issuing new cards
• Other account-related reasons.

Let me emphasize this again: Medicare will never call you for these reasons.

Even if the phone number looks legitimate and the caller sounds professional, the moment you’re asked for personal details or payments, you know it’s a scam.

What to do if you suspect a Medicare scam

If it’s a phone call, just hang up.

You don’t need to explain yourself or engage in a conversation with scammers. If they threaten you with consequences, do not believe them; scammers use fear to pressure you into making poor decisions.

Remember: If Medicare or its service providers had important information to communicate, they would do so by mail, not by phone.

Apart from not letting scammers take advantage of you, you can also help others by:

• Reporting the fraud to Medicare at 1‑800‑MEDICARE (1‑800‑633‑4227)
• Reporting the fraud to the US Department of Health and Human Services
• Reporting the fraud to the Federal Trade Commission (FTC)

How to make yourself less of a target of Medicare scams

You don’t have to sit tight and hope that scammers won’t target you. Instead, you can take some active measures to make such attempts less likely.

Monitor your Medicare statements regularly

Always review your Medicare Summary Notices (MSNs) or Explanation of Benefits (EOBs). These statements show what services have been billed in your name. If you see charges for services, equipment, or prescriptions you never received, report it right away. Quick action can stop fraud before it impacts your care.

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Pharmacist doesn’t want to deal with “narcotic ppl”

If anyone get themself facing such a situation, please know that all pharmacies are required to keep a perpetual inventory of all C-2 meds. I would just asked the pharmacist if you got one of the state pharmacy board inspectors to come in and validate that on this particular date and checked to see if the pharmacy had inventory of the particular med(s) that they told you they didn’t have inventory. That you wonder if the BOP would consider lying to a pt about inventory would be unprofessional conduct?

Below I shared the Pharmacist’s Oath and feel free to read the FIRST LINE!

Oath of a Pharmacist

The revised Oath was adopted by the AACP Board of Directors and the APhA Board of Trustees in August 2025.

“I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow:

I will consider the welfare of humanity and relief of suffering my primary concerns.
I will promote inclusion and belonging, respect differences in all individuals, and address health disparities to advance health equity for all people.
I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for all patients.
I will respect and protect all personal and health information entrusted to me.
I will accept the responsibility to improve my professional knowledge, expertise, and self-awareness.
I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct.
I will embrace and advocate changes that improve patient care.
I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.”

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compare the following article’s health outcomes with the USA’s given the fact that Rx opioids peaked in 2010-2011 – suggesting less treatment for pain as well as the 2016 CDC opioid dosing guidelines – suggesting less treatment for chronic pain and when did the increase in illegal fentanyl start rising and poisoning/ODing from people using illegal street opioids and other illegal substances The 2010s marked a decade of continued global health improvement, with most countries reporting fewer deaths from chronic diseases from 2010 to 2019.
The probability of dying from a non-communicable disease (NCD) between birth and age 80 years during this time period fell in about 80% of 185 participating countries and territories around the world included in the study, based on 2021 World Health Organization Global Health Estimates.
Although the U.S. fell into the list of countries that made survival gains in the 2010s, this progress was not much to celebrate as it was nothing like it had been in the 2000s, reported Majid Ezzati, PhD, of Imperial College London, and colleagues in the NCD Countdown 2030 project, in [The Lancet](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01388-1/fulltext)
“Females and males in the USA had the smallest declines in the probability of dying from [an NCD] before age 80 years from 2010 to 2019 of any high-income western country; those in Germany had the second smallest for females and third smallest for males. These countries’ poor performance was a consequence of having had some of the largest slowdowns in NCD mortality decline compared with the first decade of the millennium, reaching near-stagnation in the case of males in the USA,” the authors wrote.
“Epidemiologically, the poor performance of the USA from 2010 to 2019 can be summarized as a rise in the probability of dying from neuropsychiatric conditions, which was not offset by the continued declines in cancers and circulatory diseases. Specifically, although mortality from most cancers, ischemic heart disease, and chronic obstructive pulmonary disease declined from 2010 to 2019, most of these declines were smaller than the preceding decade,” they added.
In most countries, a slowdown in circulatory disease deaths drove the net decline in NCD mortality from 2010 to 2019. This decline was more modest during 2010-2019 than it had been during 2001-2010 in most countries — except in countries in central and eastern Europe and some countries in central Asia, where the declines were larger in 2010-2019.
Meanwhile, lung cancer deaths fell substantially in 2010-2019 in many countries, especially for men.
Other cancers also contributed toward fewer NCD deaths from 2010 to 2019, like stomach and colorectal cancers for both sexes, cervical and breast cancers for women, and prostate (in addition to lung) cancer for men, while pancreatic and liver cancers contributed towards higher NCD mortality.
Study authors determined that South Korea, Moldova, Denmark, Mongolia, Kazakhstan, Colombia, and Chile were the countries in their respective regions with exemplary improvements in NCD mortality from 2010 to 2019.
“Our results and the experiences of countries with strong performance indicate that what is needed is investment or reinvestment in programs that increase the coverage of efficacious diagnosis and treatment, and effective policies, such as those related to tobacco and alcohol control that are well established, or emerging ones such as those related to pricing and availability of healthy (e.g., fresh fruits and vegetables) or unhealthy (e.g., trans fat and sugar-sweetened beverages) foods,” according to Ezzati’s group.
“Crucially, these programs should be designed to reach the people that account for the largest number of disease cases and deaths, yet are persistently and increasingly excluded from the benefits of health policies and programs,” they noted.
For their study, Ezzati and colleagues assessed mortality from NCDs such as cancer, cardiovascular disease, diabetes, kidney disease, liver disease, and neurological conditions.
Across high-income western countries, NCD mortality trended downward, with Denmark showing the biggest decline and the U.S. the smallest decline.
Elsewhere, there were notable drops in NCD mortality in China, Egypt, Nigeria, Russia, and Brazil.
India and Papua New Guinea were among the roughly 20% of countries that had NCD deaths rise from 2010 to 2019.

Yes, all the other lines in the chart—except the prescription opioid dispensing line—represent death rates from specific health causes:

Chart Line Interpretations

• Global NCD mortality percent change: Shows annual improvement (declining death rates) from non-communicable diseases (e.g., heart disease, cancer, diabetes) worldwide.

Timeline comparison: Global vs U.S. NCD improvements, opioid prescribing, CDC guidelines, and rise of synthetic opioid deaths, 2010–2025

• U.S. NCD mortality percent change: Shows annual improvement (declining death rates) from non-communicable diseases specifically in the U.S..

• Synthetic opioid overdose deaths per 100,000: Represents annual U.S. death rates from overdoses involving synthetic opioids, mainly illegal fentanyl and its analogs.

Exception

• Prescription opioid dispensing per 100,000: This line shows how many people were prescribed opioids, not deaths, and is included for context on changes in medical opioid availability.

All charted lines (except Rx dispensing) are population-adjusted death rates for the respective causes.

---

can you divide up the Rx opioid line between acute Rxs and chronic Rxs?

Yes, prescription opioid dispensing can be divided between acute (short-term, <30 days) and chronic (long-term, ≥30 days) prescriptions, with national trends showing the following:

Acute vs Chronic Rx Opioid Dispensing

• Acute prescriptions (less than 30 days): Historically made up the majority of opioid prescriptions. Rates for these declined 20% from 2012 to 2015, from about 53 per 100 persons to roughly 42 per 100 persons.cdc

• Chronic prescriptions (30 days or more): These increased until about 2012–2013 and leveled off. Chronic opioid prescribing rates were about 28 per 100 persons as of 2012 and remained relatively stable through 2015, then declined after CDC guidelines in 2016.jamanetwork+1

• By the late 2010s, about 3–4% of the U.S. adult population was prescribed chronic (long-term) opioid therapy at some point each year.jamanetwork+1

2025 Estimates

• Most prescriptions are now for acute pain, as doctors sharply reduced chronic therapy after 2016. Likely, fewer than 2% of Americans receive chronic opioid prescriptions in 2025, with the rest acute.pmc.ncbi.nlm.nih+1

• The line’s values (near 100/100,000 population) would split roughly 70% acute, 30% chronic—reflecting a widely reported shift away from chronic pain prescribing after 2016.cdc+2

Would you like a new chart showing separate lines for acute and chronic opioid dispensing?

Yes, that is correct: while estimates suggest up to 100 million Americans live with some form of chronic pain, data indicate that only about 2–4% of adults were receiving long-term opioid therapy by the late 2010s—and this has declined even further post-2016, likely below 2% in 2025.cdc+3

Chronic Pain Prevalence vs Opioid Therapy

• Chronic pain population:

  • Studies and CDC reports estimate between 50 and 100 million Americans experience chronic pain, depending on defining criteria (e.g., pain most days, or every day, for ≥3 months).frontiersin+1

• Opioid therapy rates:

  • Prior to 2016, approximately 3–4% of U.S. adults were on long-term opioid prescriptions annually.pmc.ncbi.nlm.nih+1

  • Post-CDC guidelines and further prescribing reductions, well under 2% are estimated to receive any form of long-term opioid therapy in 2025, despite the large chronic pain population.cdc+2

Key Takeaway

• The vast majority of chronic pain patients are not receiving long-term opioid therapy, highlighting a large untreated or undertreated group—particularly after aggressive policy cutbacks since 2016

Yes, that is correct: while estimates suggest up to 100 million Americans live with some form of chronic pain, data indicate that only about 2–4% of adults were receiving long-term opioid therapy by the late 2010s—and this has declined even further post-2016, likely below 2% in 2025.cdc+3

Chronic Pain Prevalence vs Opioid Therapy

• Chronic pain population:

  • Studies and CDC reports estimate between 50 and 100 million Americans experience chronic pain, depending on defining criteria (e.g., pain most days, or every day, for ≥3 months).frontiersin+1

• Opioid therapy rates:

  • Prior to 2016, approximately 3–4% of U.S. adults were on long-term opioid prescriptions annually.pmc.ncbi.nlm.nih+1

  • Post-CDC guidelines and further prescribing reductions, well under 2% are estimated to receive any form of long-term opioid therapy in 2025, despite the large chronic pain population.cdc+2

Key Takeaway

• The vast majority of chronic pain patients are not receiving long-term opioid therapy, highlighting a large untreated or undertreated group—particularly after aggressive policy cutbacks since 2016.jamanetwork+3

Recent data show that of the <2% of chronic pain patients receiving long-term opioid therapy in the U.S., an estimated 13–18% are being treated with buprenorphine (Suboxone or similar formulations) specifically for chronic pain—not opioid use disorder.pubmed.ncbi.nlm.nih+2

Buprenorphine (Suboxone) Use in Chronic Pain

• A 2023–2024 outpatient study showed that buprenorphine accounted for 13–18% of all long-acting opioid prescriptions for chronic pain, with its share steadily increasing as providers seek safer alternatives to traditional opioids.pubmed.ncbi.nlm.nih

• Clinical reviews and recent practice guidelines confirm a noticeable shift toward buprenorphine for chronic pain, but the majority of long-term opioid therapy still involves full opioid agonists (e.g., oxycodone, morphine, hydrocodone).pmc.ncbi.nlm.nih+1

• For comparison, buprenorphine is much more frequently prescribed for opioid use disorder than for chronic pain.kff

• Many pain specialists project further growth in chronic pain buprenorphine prescribing, given its lower risk of overdose/tolerance and favorable safety profile for complex patients.frontiersin+2

Breakdown (2025 Estimates)

• Total chronic pain adults treated with long-term opioids: Less than 2% of the chronic pain population.

• Of those, buprenorphine (Suboxone/etc) for pain: Roughly 13–18% (potentially reaching 1 in 5 as acceptance grows).

Most of the remaining chronic pain patients receiving opioid therapy continue to be prescribed traditional full opioid agonists rather than buprenorphine.

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