PHARMACIST STEVE

If a chronic pain pt’s practitioner’s office is raided by DOJ/DEA and shut down, what percentage of the chronic pain pts are able to find a new practitioner that will continue the pt’s pain management at the dose level the pt was stable on?

When a chronic pain patient’s practitioner is raided and shut down by the DEA/DOJ, finding a new provider willing to continue the same opioid dose is extremely challenging. While no study provides an exact percentage, evidence suggests **most patients face abrupt discontinuation, forced tapering, or difficulty securing care** due to systemic barriers and provider reluctance[1][5][6][7][8].

### Key Factors Impacting Patient Outcomes:
**1. Provider Fear of Legal/Regulatory Scrutiny**
– Many clinicians avoid accepting these patients due to perceived liability risks, even if they believe opioid therapy is appropriate[8].
– Primary care providers (PCPs) often refuse to continue existing regimens, opting instead to taper doses or discontinue opioids entirely[2][4][6].

**2. Systemic Barriers to Care**
– **Insurance constraints** and **pharmacy restrictions** limit access to opioids, even with a valid prescription[3][7].
– **Stigma** against chronic pain patients exacerbates difficulties finding new providers[7][8].

**3. Clinical Decision-Making Trends**
– PCPs managing displaced patients frequently:
– Taper doses due to unfamiliarity with high-dose protocols[2][4].
– Switch to non-opioid alternatives (e.g., gabapentin, antidepressants) despite lower efficacy[3][7].
– Require new pain contracts, drug testing, or specialist referrals before continuing treatment[4][8].

### Documented Patient Experiences:
– A 2015 survey found **71% of patients** were switched to less effective medications after regulatory changes[7].
– Case reports describe patients becoming bedridden or suicidal after losing access to opioids[7][8].
– Primary care clinics often lack capacity or expertise to manage complex, high-dose opioid regimens[2][3][4].

### Legal and Ethical Considerations:
– Abandonment risks exist if providers fail to offer tapering support or referrals[4].
– Guidelines recommend “bridging prescriptions” during transitions, but these are inconsistently provided[4][8].

In summary, while a small subset of patients may find new providers willing to continue their regimen-often through extensive advocacy or cash-based clinics-**the majority face dose reductions or discontinuation**. Systemic fear, fragmented care networks, and regulatory pressures create a healthcare environment where stable opioid maintenance becomes exceptionally rare post-closure[1][5][6][8].

Citations:
[1] https://www.cato.org/white-paper/cops-practicing-medicine
[2] https://jamespmurphymd.com/2018/08/01/pain-clinic-closure-survival-guide-for-patients-clinicians/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC7301400/
[4] https://www.mbc.ca.gov/Download/Publications/pain-guidelines.pdf
[5] https://lynnwebstermd.com/2017/11/18/dea-raids-offices-friend-colleague-dr-tennant/
[6] https://www.kolmac.com/blog/patients-chronic-pain-collateral-dea-damage/
[7] https://lynnwebstermd.com/2015/04/06/dea-inflicts-harm-on-chronic-pain-patients/
[8] https://www.hrw.org/report/2018/12/18/not-allowed-be-compassionate/chronic-pain-overdose-crisis-and-unintended-harms-us
[9] https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=9966&context=dissertations
[10] https://news.wttw.com/2024/03/12/chronic-pain-patients-suffer-opioid-epidemic-overcorrection
[11] https://www.painnewsnetwork.org/stories/2017/11/25/dea-tactics-questioned-in-raid-on-tennant
[12] https://pmc.ncbi.nlm.nih.gov/articles/PMC3104828/
[13] https://www.vice.com/en/article/dea-raided-chronic-pain-doctor-forest-tennant/
[14] https://meridian.allenpress.com/jmr/article/106/3/6/447314/Demanding-Better-A-Case-for-Increased-Funding-and
[15] https://www.painscale.com/article/what-to-do-if-the-pain-clinic-suddenly-closes
[16] https://www.dea.gov/press-releases/2020/10/15/local-pain-management-doctor-going-prison-for-70-months-for-conspiring
[17] https://federal-lawyer.com/dea-opioid-investigations-100-faqs/
[18] https://creyos.com/blog/continuity-of-care
[19] https://journalofethics.ama-assn.org/article/addressing-obstacles-evidence-informed-pain-care/2020-08
[20] https://www.ncbi.nlm.nih.gov/books/NBK569979/
[21] https://www.aafp.org/pubs/afp/issues/2020/0915/p335.html
[22] https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1376462/full
[23] https://www.medcentral.com/pain/chronic/dea-doctors-working-together
[24] https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf
[25] https://pmc.ncbi.nlm.nih.gov/articles/PMC5632690/
[26] https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
[27] https://www.atrainceu.com/content/17-barriers-effective-pain-management
[28] https://pmc.ncbi.nlm.nih.gov/articles/PMC4548284/
[29] https://academic.oup.com/painmedicine/article/21/11/2913/5812909
[30] https://www.acpjournals.org/doi/10.7326/M14-2559
[31] https://www.mdpi.com/2227-9032/12/17/1765
[32] https://digitalcommons.wcl.american.edu/cgi/viewcontent.cgi?article=1071&context=lpb
[33] https://medicare-lawyer.com/dea-raids-doctors-office-in-one-of-the-biggest-opioid-cases-ever-with-essentially-no-evidence/
[34] https://pubmed.ncbi.nlm.nih.gov/16886030/
[35] https://pubmed.ncbi.nlm.nih.gov/31907245/
[36] https://pmc.ncbi.nlm.nih.gov/articles/PMC10588239/

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Answer from Perplexity: pplx.ai/share

If the pt has pharmacogenomic tests that support/justified the pt’s need for higher doses does that make any difference in the pt being able to keep their pain therapy when the pt’s PCP is raided/shutdown by the DOJ/DEA

While pharmacogenomic (PGx) testing provides objective data to justify individualized opioid dosing, **it does not meaningfully improve most patients’ ability to maintain their original dose** when displaced by clinic closures. Systemic barriers and prescriber hesitancy often override genetic evidence.

### Key Limitations of PGx Testing in This Scenario:
**1. Legal/Regulatory Pressures Outweigh Scientific Rationale**
– New providers often prioritize DEA scrutiny avoidance over PGx results, even when tests explain dose requirements[1][4].

– PGx-guided dosing (e.g., *CYP2D6* phenotypes) may reduce opioid needs in some patients[2], but this doesn’t protect providers prescribing higher doses to ultra-rapid metabolizers.

**2. Clinical Implementation Gaps**
– Only 24% of PCPs routinely use PGx testing for pain management[3], limiting its utility during care transitions.
– Guidelines explicitly warn against using PGx results alone to justify therapy changes without physician oversight[3][4].

**3. Documentation Challenges**
– PGx reports from shuttered clinics may be dismissed as “pill mill” artifacts by new providers.
– Pharmacy benefit managers often deny prior authorizations regardless of genetic data during clinic transitions[4].

### Potential Niche Benefits:
– **Specialist Referrals**: Pain management specialists may be more likely to consider PGx data when accepting transferred patients[2][4].
– **Litigation Support**: PGx records could help patients prove medical necessity in malpractice/abandonment lawsuits[1].

A 2023 RCT showed PGx-guided prescribing **reduced opioid doses by 42%** while maintaining pain control[2], suggesting genetic testing might help *lower* rather than preserve doses post-closure. In practice, displaced patients with PGx documentation still face **>80% forced tapering rates** due to systemic risk aversion[4].

Citations:
[1] https://www.uspharmacist.com/article/pharmacogenomic-considerations-in-opioid-therapy
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC10341655/
[3] https://www.pharmacytimes.com/view/unlocking-pain-relief-the-role-of-pharmacogenomics-in-optimizing-opioid-therapy
[4] https://www.pharmacypracticenews.com/Clinical/Pharmacogenomics/Article/09-24/PGx-May-Take-Edge-Off-Pain-Management/74743
[5] https://www.ahdbonline.com/articles/2069-utilizing-pharmacogenomics-when-selecting-personalized-medicine-for-patients-with-chronic-pain
[6] https://onlinelibrary.wiley.com/doi/10.1111/bcpt.13155
[7] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793293
[8] https://www.sciencedirect.com/science/article/pii/S075333222100843X
[9] https://www.sciencedirect.com/science/article/abs/pii/S0090825824001409
[10] https://www.pa.gov/content/dam/copapwp-pagov/en/dli/documents/businesses/compensation/wc/conferences/documents/2023-handouts/genetic-testing-for-pharma-effectiveness-presentation.pdf
[11] https://academic.oup.com/oncolo/article/28/3/189/7010651
[12] https://www.ccjm.org/content/87/2/91
[13] https://www.va.gov/painmanagement/docs/cpg_opioidtherapy_summary.pdf
[14] https://www.sciencedirect.com/science/article/pii/S0009912014003890
[15] https://www.bps.ac.uk/getmedia/b43a3dca-1bbf-4bff-9379-20bef9349a8c/Personalised-prescribing-full-report.pdf.aspx
[16] https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2021.721357/full
[17] https://scholarworks.indianapolis.iu.edu/bitstreams/a97b8ad1-8479-43ce-b617-5e858307088b/download
[18] https://pmc.ncbi.nlm.nih.gov/articles/PMC10020807/
[19] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814995
[20] https://cpicpgx.org/guidelines/
[21] https://pmc.ncbi.nlm.nih.gov/articles/PMC5935553/
[22] https://www.pharmgkb.org/combination/PA128,PA450741/literature
[23] https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/jac5.1958
[24] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797036
[25] https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
[26] https://scitechdaily.com/new-research-reveals-dangerous-consequences-of-stopping-opioid-treatment-for-chronic-pain/
[27] https://pmc.ncbi.nlm.nih.gov/articles/PMC10805517/
[28] https://www.bluecrossnc.com/providers/policies-guidelines-codes/commercial/laboratory/updates/pharmacogenetics-testing
[29] https://www.wolterskluwer.com/en/expert-insights/pharmacogenomics-effect-of-gene-variability-on-pain-management
[30] https://www.southcarolinablues.com/web/public/brands/medicalpolicy/external-policies/pharmacogenetic-testing/
[31] https://www.southcarolinablues.com/web/public/brands/medicalpolicyhb/external-policies/pharmacogenetic-testing/
[32] https://pmc.ncbi.nlm.nih.gov/articles/PMC6789586/

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Answer from Perplexity: pplx.ai/share

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