Killing Them Quietly

Killing Them Quietly

Government versus Medicine

A war is raging in America today, between physicians treating pain and addiction, and the United States federal government (mostly the DEA) on the proper practice of medicine. While the federal government is forbidden by law from trying to influence the practice of medicine, according to Lambert v. Yellowly, 1926, where the Supreme Court ruled that “direct control of medical practice in the States is beyond the power of the Federal Government.” Based on Linder v. United States, 268 U.S. 5, 18, where it was ruled that “Congress, therefore, cannot directly restrict the professional judgment of the physician or interfere with its free exercise in the treatment of disease. Whatever power exists in that respect belongs to the states exclusively.”

This was followed by a Medicare statute, 42 USC 1395, that expressly forbade the federal government from interfering with the practice of medicine, stating: “Nothing in this subchapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.”

These precepts were further affirmed by the US Supreme Court in Gonzales v. Oregon, where the US Supreme Court forbade the US Attorney General from enforcing the Controlled Substances Act against physicians who were prescribing medications in accordance with state law. In this case, the state of Oregon had passed legislation allowing physicians, in very narrow circumstances, to prescribe a medication for the express purpose of ending someone’s suffering by ending their lives. As of that lawsuit, 935 people had exercised their right under Oregon law, to end their suffering under their own terms, and the physicians had been protected from prosecution. The AG threatened to prosecute the doctors, and the physicians sued, eventually ending up in front of the Supreme Court and winning.

Then we had Xiulu Ruan v. United States. Where two physicians had been prosecuted for being “outside the usual practice of medicine” and prescribing controlled substances “without a legitimate medical purpose.” These ill-defined concepts heretofore being left to the government’s creation out of whole cloth. In this case the trial court b had instructed the jury that the doctors’ subjective belief that they were acting in good faith didn’t matter if the government was able to persuade the jury that the doctor’s practice deviated from “the norm.” According to one government expert in sworn testimony the norm exists only in the minds of government experts and cannot be found in any book or database. After the physicians were convicted their appeal ended up in front of the US Supreme Court.

The Court immediately saw the injustice in the government’s argument, stating that the law was ““ambiguous,” written in “generalit[ies], susceptible to more precise definition and open to varying constructions.” Further ruling that, without mens rea, a “vicious mind”, and clear knowledge of wrongdoing, a physician should not be declared criminal. This comports with a long held precept of American law that a serious crime requires proof the person knew what they were doing was wrong and did it anyway. The Court also ruled that the doctor should not have to prove that their mental state was that of a “hypothetical ‘reasonable’ doctor.” Finding that “…for purposes of a criminal conviction under §841, this requires proving that a defendant knew or intended that his or her conduct was unauthorized.”

That should have settled matters, but it did not. It is not common for the executive branch of the United States of America to refuse to follow the judicial branch’s interpretation of the law. In fact, I can find only two examples of this happening. The first of these was in 1832, in the case of Worcester v. Georgia. This case involved the Cherokee Nation, which had adapted better than most Native American tribes to life in the new American nation. They had developed a written language, and newspapers, and many had sent their children to universities and even law school. When the state of Georgia tried to control lands guaranteed to the Cherokee by treaty, they met fierce and eloquent opposition, and the US Supreme Court rule that the states did not have the right to impose regulations on Native American land. But the current president, Andrew Jackson, refused to enforce that ruling, saying of Chief Justice Marshall, “Now let him enforce it.” and refusing to protect the rights elucidated by the Supreme Court The states eventually seized most of the land set aside for Native Americans by treaty, leading eventually to the Trail of Tears.

The first Trail of Tears in 1838 had a 27% mortality rate, resulting in the deaths of 4,000 Native Peoples on that first death march. The states were so pleased with that result that they did it repeatedly over the next decade and a half. Eventually killing more than fifteen thousand and displacing over one hundred thousand. Today, there is a new Trail of Tears being created, by the DEA’s refusal to honor the ruling of the US Supreme Court in Ruan. Doctors are being prosecuted for the non-crimes of prescribing “dangerous medications in dangerous combinations,” (which is the very definition of what distinguishes a physician from every other profession…) to patients who “travel long distances for treatment.” Of the twelve listed “pill mill” descriptors pried from government records. None are crimes. In many cases, the government does not try to prove or even allege that the doctor had criminal intent, arguing only that he was “willfully blind” to the nebulous standard espoused by a medical expert witness of doubtful qualification, who has been paid to advance their opinion and convince the jury.

The government is pursuing a theory that the prescribing of opiate medications led to the current opioid epidemic. Nothing could be further from the truth. In the early 1990s it was recognized that untreated chronic pain reduced the quality and shortened the lives of those suffering from it. While pain itself is sometimes argued to not be fatal, this argument would instantly be recognized by any Civil War physician as inconsistent with evidence based medical practice. Without adequate analgesia, the simple amputation of a limb was found to cause death by shock if it took longer than fifteen minutes. Not from blood loss mind you. This was controlled by a tourniquet. But instead from the severe pain causing the heart to fail. It has been proven that even the psychological pain of a broken heart can have this effect. The proof that pain was causing death can be found in modern operating rooms, where, with the use of modern anesthetics, patients can survive hours of surgery without cardiac failure.

Severe chronic pain damages the heart by increasing sympathetic nervous system activation, increasing cardiac contractility and blood pressure, causing the heart to be overworked, predisposing it to arrhythmia and dysregulation of cardiac function. Chronic pain also increases stress hormone levels which increase the inflammatory response. Over time this leads to cardiac stress and arterial endothelial dysfunction and plaque formation, leading to coronary and arterial occlusion that causes heart attacks and strokes. A study in published by Harvard Health showed that people with chronic pain are 20% more likely to have a heart attack and 30% more likely to have a stroke, adjusting for factors like diabetes etc. These facts have long been well understood by the medical community, and treating chronic pain to make it tolerable was considered a basic function of primary care medicine.

By the early 2000s several states had passed pain treatment acts protecting physicians who treated pain from prosecution, recognizing that family and law enforcement may not understand the practice of medicine well enough not to blame a physician for any bad outcome. Leaving it to the state medical boards to police the practice of medicine, suspending or revoking a physician’s license under their state appointed authority. Opiate medication prescriptions peaked around 2012, as physicians sought to balance the need to control pain with the need to prevent overuse, addiction, and diversion. Then came the Fentanyl epidemic, where uncontrolled border checkpoints allowed a nonstop flow of this extremely potent opiate into the country. Since the early 1900s, heroin, invented as a “nonaddictive” treatment for morphine addiction, was the major opiate of abuse in America.

Heroin is bulky and hard to smuggle, but fentanyl, being much more potent, could have the same effect in milligrams that took kilograms of heroin. Hiding thirty pounds of something can be tough. Hiding three ounces is a lot easier. But fentanyl wasn’t well known on the black market, so the drug dealers used it to make fake heroin. If they had carefully calibrated the fake heroin to have the same potency as real heroin, the overdose rate would not have changed, but that’s asking too much of people who smuggle and deal drugs. Invariably they would put in too much, and people who thought they were taking there usual dose would die. This led to a sharp spike in fentanyl related deaths starting in 2013. Since fentanyl CAN be prescribed, every one of these deaths was initially reported as a prescription opiate related death. Even though comparing the rates of prescribed fentanyl to the death rate proves there is no correlation whatsoever. In 2018, the US Bureau of Vital Statistics was forced to correct its methods, reducing the number of deaths involving prescription drugs by at least half.

Fentanyl is very rarely prescribed to persons without cancer except in a patch form that is hard to abuse and not related to any significant overdose risk. As the deaths related to Fentanyl continued to climb, reaching 9,580 in 2015, the federal government saw an opportunity to intervene, and the CDC wrote the now somewhat infamous guidelines on prescription of opioids to adults with chronic pain. What started as a simple caution to primary care providers to be careful at certain levels of pain medication treatment, became a mandate to limit pain management, and finally, even a weapon to use against board certified pain specialists. With this cudgel in hand the DEA rapidly began prosecuting any physician who was perceived to be outside the limits of prescribing as defined by the CDC. States got in on the act, suing pharmaceutical companies for excessively promoting pain medications and creating laws in line with the CDCs guidelines.

As acknowledged publicly by the CDC in 2018, the problem was that these guidelines were never meant to become mandated limits on physicians. They were supposed to be just a reminder to be cautious. It is not that the guidelines were completely without merit, it’s that they were concocted without any real evidence and deeply influenced by anti-opioid bias. As some have acknowledged on video, there was not time for evidence, opinion would have to suffice. Opinion is fine when the professional is free to make exceptions. However, it becomes a government enforced ideology when they are not-which is precisely what the DEA has done. Physicians’ offices were raided, and the doctors paraded to the public as if they were Pablo Escobar. This witch hunt turned out to be a windfall for the federal government, as they seized physicians’ assets and made headlines, all the while avoiding the real drug dealers who might shoot back. For every doctor prosecuted, over a thousand patients were left stranded.

Following its unjustified persecutions of particular doctors, the DEA would then monitor these patients to see where they went, targeting doctors who accepted these medical refugees as patients. One needs only look at the tragic suicides of Daniel and Gretchen Elliot in 2022, when their doctor, Dr. Sachy, was targeted and shut down. Fleeing to Dr. Bockoff just set that doctor up for targeting. When Bockoff was shut down no one would treat them. Gretchen and Daniel took their lives together when his pain became intolerable, and his loss was more than she could bear. Now the formula for a perfect storm was complete. Heroin addicts overdosing on fentanyl which was then reported as a prescription medication death led to the targeting of doctors which in turn led to chronic pain patients having nowhere to go, sending them to the streets searching for medications. Which created the perfect opportunity for true “pill mills”.

A real pill mill is where fake pills made to look exactly like hydrocodone or oxycodone are made using pill presses that can be purchased online. These pills fooled the abandoned patients, who rapidly died of an overdose when the fentanyl level was too high. These were also reported as prescription related deaths. The DEA tried to shut these down with limited success, but this was hard and they were under pressure. So they started calling any practice that treated a lot of pain patients a “pill mill” something that judges routinely allowed them to repeat in court.

Let’s put some things in perspective. There were 336,997,624 people in the United States in 2021. During that same year 3,458,697 people died. That’s almost exactly 1%, 1.03% in fact. Of those deaths, 107,622 involved drug overdose. That’s 3.1% of all deaths. Stimulants like methamphetamine and cocaine accounted for another 26,806 deaths, sometimes overlapping deaths where opioids were involved. 88% of opioid involved deaths were due to illegal fentanyl-about 75% of all deaths involving a drug of any type. Almost NONE of this fentanyl comes from prescriptions. Fentanyl is used almost exclusively in the hospital, surgical, and emergency environments. It is extremely rare to get an outpatient fentanyl prescription, and these are usually reserved for cancer patients. Most remaining opiate related deaths are associated with heroin.

In that same year, from the DEA press release website, I can immediately find eighteen cases of doctors being shut down or sent to prison. Many of these were for prescriptions written years earlier, identified by data mining algorithms that target doctors based on the how busy their practice is, how much insurance companies have to pay for testing etc., how far their patients drive, and whether or not they own lake front or beach front property. In 2021 alone, just from these numbers, we’ll have at least eighteen healthcare providers shut down. That leaves about 36,000 people searching for a physician to help them. The DEA is actively tracking patients from a prosecuted doctor and targeting any physician who treats those patients for their pain. A study completed in 2021 found that about 36% of patients could not find any doctor willing to treat their pain, and that study was on patients whose doctor had NOT been targeted. Add all of these to the to that original more than one third of severe chronic pain sufferers that could already NOT find treatment before this madness started.

And what is the result? The DEA acts like cutting people off their treatment or not treating them at all with any effective medication is some kind of solution. It is not. Untreated and undertreated chronic pain sufferers are 20% more likely to have a heart attack and 30% more likely to have a stroke than the general population. They are also more likely to commit suicide. Ten percent of all suicides are linked to severe chronic pain. From my estimates we now have at least 6,156,000 people with severe life-limiting chronic pain that cannot find treatment. What is also not pointed out by the federal authorities, is how many of those patients suffering from untreated chronic pain in a world where it is no longer safe for doctors to treat them, will go to the streets. Finding fentanyl laced fake pills rather than their expected medication. The evidence is clear. In their misguided attempts to stop prescription opiate overdose, which accounts for less than five hundred deaths per year, the US federal government is killing tens of thousands. They may be killing them quietly and indirectly, but those patients are dead just the same.

2 Responses

  1. The ” war on drugs ” is killing the chronic pain community . I thought we were a civilized society. I guess I was wrong.

  2. I’m getting so tired of the same ball being kicked around by everyone, with no solution stated. We, on, explain the solution. If you want this to end, learn what we teach and let’s end the attacks by the government. The CSA was created, as the war on drugs, as a racist tool to disenfranchise minorities. No drug causes addiction. We teach the real cause which people need to learn, because almost everyone in America now is at risk for becoming an addict due to their lifestyle.

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