PHARMACIST STEVE

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

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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)

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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)

Filed under: General Problems