National Sickle Cell Awareness Month

Posted on September 1, 2025 by Pharmaciststeve

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September is Chronic Pain & Suicide Awareness month

Posted on August 31, 2025 by Pharmaciststeve


National Suicide Prevention Awareness Month - Volunteers ...

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Urge Media to Highlight Harm of Opioid Therapy Restrictions

Posted on September 23, 2025 by Pharmaciststeve

https://www.change.org/p/urge-media-to-highlight-harm-of-opioid-therapy-restrictions

The Issue

Chronic pain patients (CPP) are facing dire consequences due to excessive restrictions on opioid therapy. With regulations limiting access to essential pain relief, thousands are left with no option but to undergo unnecessary procedures like epidurals and nerve ablations, which not only fail to address their pain but can also cause significant harm to their bodies. This situation has left many CPPs bedridden, stripped of their quality of life (QOL), and unable to participate in their own lives.

The DEA’s role in enforcing these restrictions has profound implications on a vulnerable population, often leaving them improperly medicated and suffering in silence. Media outlets have a critical role in shedding light on the individual stories of pain, suffering, and the anguish experienced by these patients who find their cries for help unheard. It’s time to showcase the real-life impact of these restrictive measures and bring a human face to the policy decisions affecting the chronic pain community.

Patient narratives illustrate the harsh reality of those who, due to the DEA’s crackdown on opioid prescriptions, face insurmountable hurdles in accessing necessary care. These stories reveal the devastating effects of being forced into ineffective and harmful treatments, ultimately worsening their physical and mental well-being.

We call on media organizations to dedicate time and resources to report on this critical issue, ensuring that the narratives of CPPs are heard. Highlighting these experiences will not only bring awareness but could also drive policy change, encouraging a reevaluation of the current approach to opioid prescription for chronic pain. Your signature can make a difference by compelling the media to take immediate action and advocate for a fairer, more compassionate approach to pain management. Sign this petition to stand with CPPs and demand media attention to this pressing human

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Our focus is really on what we can do to pull the doctor out of the visit

Posted on September 22, 2025 by Pharmaciststeve

This medical startup uses LLMs (Large Language Model) to run appointments and make diagnoses

https://www.technologyreview.com/2025/09/22/1123873/medical-diagnosis-llm/

Imagine this: You’ve been feeling unwell, so you call up your doctor’s office to make an appointment. To your surprise, they schedule you in for the next day. At the appointment, you aren’t rushed through describing your health concerns; instead, you have a full half hour to share your symptoms and worries and the exhaustive details of your health history with someone who listens attentively and asks thoughtful follow-up questions. You leave with a diagnosis, a treatment plan, and the sense that, for once, you’ve been able to discuss your health with the care that it merits.

Related Story

The catch? You might not have spoken to a doctor, or other licensed medical practitioner, at all.

This is the new reality for patients at a small number of clinics in Southern California that are run by the medical startup Akido Labs. These patients—some of whom are on Medicaid—can access specialist appointments on short notice, a privilege typically only afforded to the wealthy few who patronize concierge clinics.

The key difference is that Akido patients spend relatively little time, or even no time at all, with their doctors. Instead, they see a medical assistant, who can lend a sympathetic ear but has limited clinical training. The job of formulating diagnoses and concocting a treatment plan is done by a proprietary, LLM-based system called ScopeAI that transcribes and analyzes the dialogue between patient and assistant. A doctor then approves, or corrects, the AI system’s recommendations.

“Our focus is really on what we can do to pull the doctor out of the visit,” says Jared Goodner, Akido’s CTO. 

According to Prashant Samant, Akido’s CEO, this approach allows doctors to see four to five times as many patients as they could previously. There’s good reason to want doctors to be much more productive. Americans are getting older and sicker, and many struggle to access adequate health care. The pending 15% reduction in federal funding for Medicaid will only make the situation worse.

But experts aren’t convinced that displacing so much of the cognitive work of medicine onto AI is the right way to remedy the doctor shortage. There’s a big gap in expertise between doctors and AI-enhanced medical assistants, says Emma Pierson, a computer scientist at UC Berkeley.  Jumping such a gap may introduce risks. “I am broadly excited about the potential of AI to expand access to medical expertise,” she says. “It’s just not obvious to me that this particular way is the way to do it.”

AI is already everywhere in medicine. Computer vision tools identify cancers during preventive scans, automated research systems allow doctors to quickly sort through the medical literature, and LLM-powered medical scribes can take appointment notes on a clinician’s behalf. But these systems are designed to support doctors as they go about their typical medical routines.

What distinguishes ScopeAI, Goodner says, is its ability to independently complete the cognitive tasks that constitute a medical visit, from eliciting a patient’s medical history to coming up with a list of potential diagnoses to identifying the most likely diagnosis and proposing appropriate next steps.

Under the hood, ScopeAI is a set of large language models, each of which can perform a specific step in the visit—from generating appropriate follow-up questions based on what a patient has said to to populating a list of likely conditions. For the most part, these LLMs are fine-tuned versions of Meta’s open-access Llama models, though Goodner says that the system also makes use of Anthropic’s Claude models. 

During the appointment, assistants read off questions from the ScopeAI interface, and ScopeAI produces new questions as it analyzes what the patient says. For the doctors who will review its outputs later, ScopeAI produces a concise note that includes a summary of the patient’s visit, the most likely diagnosis, two or three alternative diagnoses, and recommended next steps, such as referrals or prescriptions. It also lists a justification for each diagnosis and recommendation.

ScopeAI is currently being used in cardiology, endocrinology, and primary care clinics and by Akido’s street medicine team, which serves the Los Angeles homeless population. That team—which is led by Steven Hochman, a doctor who specializes in addiction medicine—meets patients out in the community to help them access medical care, including treatment for substance use disorders. 

Previously, in order to prescribe a drug to treat an opioid addiction, Hochman would have to meet the patient in person; now, caseworkers armed with ScopeAI can interview patients on their own, and Hochman can approve or reject the system’s recommendations later. “It allows me to be in 10 places at once,” he says.

Since they started using ScopeAI, the team has been able to get patients access to medications to help treat their substance use within 24 hours—something that Hochman calls “unheard of.”

This arrangement is only possible because homeless patients typically get their health insurance from Medicaid, the public insurance system for low-income Americans. While Medicaid allows doctors to approve ScopeAI prescriptions and treatment plans asynchronously, both for street medicine and clinic visits, many other insurance providers require that doctors speak directly with patients before approving those recommendations. Pierson says that discrepancy raises concerns. “You worry about that exacerbating health disparities,” she says.

Samant is aware of the appearance of inequity, and he says the discrepancy isn’t intentional—it’s just a feature of how the insurance plans currently work. He also notes that being seen quickly by an AI-enhanced medical assistant may be better than dealing with long wait times and limited provider availability, which is the status quo for Medicaid patients. And all Akido patients can opt for traditional doctor’s appointments, if they are willing to wait for them, he says.

Part of the challenge of deploying a tool like ScopeAI is navigating a regulatory and insurance landscape that wasn’t designed for AI systems that can independently direct medical appointments. Glenn Cohen, a professor at Harvard Law School, says that any AI system that effectively acts as a “doctor in a box” would likely need to be approved by the FDA and could run afoul of medical licensure laws, which dictate that only doctors and other licensed professionals can practice medicine.

The California Medical Practice Act says that AI can’t replace a doctor’s responsibility to diagnose and treat a patient, but doctors are allowed to use AI in their work, and they don’t need to see patients in-person or in real-time before diagnosing them. Neither the FDA nor the Medical Board of California were able to say whether or not ScopeAI was on solid legal footing based only on a written description of the system.

But Samant is confident that Akido is in compliance, as ScopeAI was intentionally designed to fall short of being a “doctor in a box.” Because the system requires a human doctor to review and approve of all of its diagnostic and treatment recommendations, he says, it doesn’t require FDA approval. 

At the clinic, this delicate balance between AI and doctor decision making happens entirely behind the scenes. Patients don’t ever see the ScopeAI interface directly—instead, they speak with a medical assistant who asks questions in the way that a doctor might in a typical appointment. That arrangement might make patients feel more comfortable. But Zeke Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania who served in the Obama and Biden administrations, worries that this comfort could be obscuring from patients the extent to which an algorithm is influencing their care.

Pierson agrees. “That certainly isn’t really what was traditionally meant by the human touch in medicine,” she says.

DeAndre Siringoringo, a medical assistant who works at Akido’s cardiology office in Rancho Cucamonga, says that while he tells the patients he works with that an AI system will be listening to the appointment in order to gather information for their doctor, he doesn’t inform them about the specifics of how ScopeAI works, including the fact that it makes diagnostic recommendations to doctors. 

Because all ScopeAI recommendations are reviewed by a doctor, that might not seem like such a big deal—it’s the doctor who makes the final diagnosis, not the AI. But it’s been widely documented that doctors using AI systems tend to go along with the system’s recommendations more often than they should, a phenomenon known as automation bias. 

At this point, it’s impossible to know whether automation bias is affecting doctors’ decisions at Akido clinics, though Pierson says it’s a risk—especially when doctors aren’t physically present for appointments. “I worry that it might predispose you to sort of nodding along in a way that you might not if you were actually in the room watching this happen,” she says.

An Akido spokesperson says that automation bias is a valid concern for any AI tool that assists a doctor’s decision-making and that the company has made efforts to mitigate that bias. “We designed ScopeAI specifically to reduce bias by proactively countering blind spots that can influence medical decisions, which historically lean heavily on physician intuition and personal experience,” she says. “We also train physicians explicitly on how to use ScopeAI thoughtfully, so they retain accountability and avoid over-reliance.”

Akido evaluates ScopeAI’s performance by testing it on historical data and monitoring how often doctors correct its recommendations; those corrections are also used to further train the underlying models. Before deploying ScopeAI in a given specialty, Akido ensures that when tested on historical data sets, the system includes the correct diagnosis in its top three recommendations at least 92% of the time.

But Akido hasn’t undertaken more rigorous testing, such as studies that compare ScopeAI appointments with traditional in-person or telehealth appointments, in order to determine whether the system improves—or at least maintains—patient outcomes. Such a study could help indicate whether automation bias is a meaningful concern.

“Making medical care cheaper and more accessible is a laudable goal,” Pierson says. “But I just think it’s important to conduct strong evaluations comparing to that baseline.”

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Does a large hospital system have any responsibility when one of their employed MD retires?

Posted on September 22, 2025 by Pharmaciststeve

A pt reached out to me with the follow issue, what is the responsibility of a large hospital system. Having several hospitals in two states and a large number of physician offices, employing 1000+ physicians.

I asked perplexity.ai?

Question: I had a chronic pain pts that reached out to me and the pt’s PCP is retiring next year and the pt’s current PCP is employed by a very large hospital system – multiple hospitals in two states and maybe upwards of a 1000+ physicians working for the system. This pt cannot find a PCP – even in the same office – that has some 10 different PCP. My thoughts dose the hospital system have any responsibility for helping this pt finding a new PCP within their system? IMO, this pt is on the cusp of being abandoned – your opinion?

A hospital system and its employed physicians have an ethical and some legal responsibilities to support continuity of care when a PCP retires, especially for chronic pain patients who are at heightened risk of abandonment if alternative care isn’t arranged. While individual physicians must notify patients, provide reasonable transition time, and continue care until proper hand off or substitute care is found, large hospital systems should facilitate this process—particularly when there are other PCPs in the same office or network.norcal-group+5

Hospital System Responsibilities

Hospital systems are expected to prevent abandonment by providing notice to affected patients and helping arrange ongoing care, either within the network or by supplying resources to find new providers. Given that your scenario involves a large system with multiple PCPs at one site, failure to offer any assistance or access within their network would constitute poor practice and might risk formal abandonment, especially if the patient is left without appropriate medical oversight or prescription management. Ethically, and under many state regulations, systems employing hundreds or thousands of physicians have added capacity (and expectation) to reassign patients internally, compared to solo or small practices.pmc.ncbi.nlm.nih+5

Chronic Pain and Risk of Abandonment

Chronic pain patients face particular vulnerability due to the complexity of their treatment regimen and the stigma attached to opioid prescribing. Abrupt discontinuation or refusal to transition care exposes them to avoidable harm and potential withdrawal, which courts and medical boards may interpret as gross negligence or reckless abandonment if reasonable transition is not achieved. Professional guidelines and precedents (AMA Code, Joint Commission pain standards) reinforce hospital and PCP duties to ensure patients are not left untreated or unsupported.pmc.ncbi.nlm.nih+4

Opinion

In this case, the hospital system should proactively facilitate PCP continuity—either by transferring care to another physician within the practice or by providing written notice and assistance in locating an appropriate provider. Failure to do so risks formal patient abandonment, especially when the system has adequate resources for such a transition. The patient in question could justifiably feel abandoned; advocacy (with state boards, patient relations, or medical directors) may be warranted if transition support isn’t provided.copic+5

  1. https://www.norcal-group.com/library/ensuring-continuity-of-care-when-retiring-or-closing-a-practice
  2. https://www.copic.com/resource/checklist-for-physicians-retiring-from-a-medial-practice/
  3. https://www.thedoctors.com/articles/closing-or-relocating-a-healthcare-practice/
  4. https://www.cmadocs.org/newsroom/news/view/ArticleId/28099/FAQ-What-is-the-proper-way-to-terminate-the-physician-patient-relationship
  5. https://code-medical-ethics.ama-assn.org/chapters/patient-physician-relationships
  6. https://www.ncbi.nlm.nih.gov/books/NBK563285/
  7. https://pmc.ncbi.nlm.nih.gov/articles/PMC7670398/
  8. https://onlinelibrary.wiley.com/doi/full/10.1002/hec.4800
  9. https://www.expertinstitute.com/resources/insights/patient-abandonment-cases-what-you-need-to-know/
  10. https://pmc.ncbi.nlm.nih.gov/articles/PMC1071521/
  11. https://www.opiates.com/opiates-blog/doctor-retiring-pain-management
  12. https://www.sciencedirect.com/science/article/abs/pii/S0047272722000056
  13. https://creyos.com/blog/continuity-of-care
  14. https://www.thedoctors.com/articles/terminating-patient-relationships/
  15. https://www.tn.gov/content/dam/tn/health/healthprofboards/pain-management-clinic/Pain_Clinic_FAQ.pdf
  16. https://seak.com/blog/uncategorized/10-biggest-legal-mistakes-physicians-make-lead-claims-patient-abandonment/
  17. https://www.reddit.com/r/ChronicPain/comments/1czzu6x/pain_doctor_retiring_now_pcp_is_saying_they_may/
  18. https://www.hollandhart.com/firing-patients-avoiding-patient-abandonment
  19. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777855
  20. https://www.tn.gov/content/dam/tn/health/healthprofboards/pain-management-clinic/ChronicPainGuidelines.pdf

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Recognition is appreciated

Posted on September 21, 2025 by Pharmaciststeve

Much to my surprise this AM, I found this graphic on another FB page that I am an administrator on. I don’t even know who created this FB page, but they made me an administrator. It is a “private FB page” and it has 2.1K members.  WAR ON PAIN PATIENTS PRIVATE GROUP

Bob Sherrin  has often said nice things about me, but Bob is so full of BS and embellishes so much, it is often hard to separate the truth from Bob’s embellishment.

I started my first FB page https://www.facebook.com/PharmacyRouletteYouBetYourLife and started my blog www.pharmaciststeve.com   back in 2012

Initially, I had no idea where this was all going, but hopefully it would grow organically, which has happened. Unlike some other advocates, I don’t ask for donations, I have never monetized any of my websites and I don’t required that I get paid for providing a chronic painer any advice.

I don’t talk about  Barb much, but she had been an intractable chronic pain pt for > 3 decades and I remember her dealing with some minor pain issues back when we started dating 60 yrs ago. I have some pain issues, but her “good days” are worse than my “bad days”

 

 

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CVS Accused of Inappropriately Using Patient Data

Posted on September 20, 2025 by Pharmaciststeve

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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updated 09202025 This is going to be an evolving story of a Disabled Female chronic pain pt

Posted on September 20, 2025 by Pharmaciststeve

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

 

 

 

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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Déjà vu: WHEN HISTORY REPEATS ITSELF

Posted on September 20, 2025 by Pharmaciststeve

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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When acceptable death rate becomes an industrial norm

Posted on September 20, 2025 by Pharmaciststeve

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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Are there some members of the House that should BE VOTED OUT NEXT YEAR?

Posted on September 20, 2025 by Pharmaciststeve

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)

Filed under: General Problems | Leave a Comment »

Perplexity.ai indicates that the DEA is not being honest on opioid OD/poison

Posted on September 18, 2025 by Pharmaciststeve

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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