PART-2, OF THE DASGUPTA, BELETSKY, CICCARONE PROTOCOLS
NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF ERLIN CLEMENT SR., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
“IF YOU EVER THINK YOU ARE TOO SMALL TO MAKE A CHANGE, THEN YOU HAVE NEVER SLEPT WITH A MOSQUITO”
October 4, 2021, in Cleveland, Ohio, the nation’s legal reckoning over the opioid crisis shifts to four name-brand pharmacy chains: CVS, Giant Eagle, Walgreens, and Walmart.
The companies say they did nothing wrong in the way of dispensing narcotic analgesic medications legally prescribed by their licensed healthcare practitioners.
The government’s case fails to establish any elements of civil negligence, criminality, or probable cause and is based solely on broad numbers (volume) medications while excluding the disease, disease states of the patients being cared for by their pharmacist.
The government’s case fails to delineate which opioid-specific types of medications are being dispensed. Using the broad phrase OPIOID conflates the usages of these medications for conditions of patients disease states and treatment while further failing to distinguish medically used medications from those that have no medical use (heroin, non-medical fentanyl) and will likely prejudice any jury.
The government’s case falsely establishes overprescribing through an unscientific flawed guideline of Morphine Milligram Equivalent (MME) limited to a one size fits all 90MME beyond which a practitioner is made fraudulently culpable of overprescribing. These guidelines, simply amount to massive government overreach into redefining the field of medicine and the privacy of the healthcare practitioner-patient relationship.
“WE ARE PHARMACISTS DISPENSING LEGALLY PRESCRIBED MEDICATIONS NOT STREET DRUG DEALERS OR TRAFFICKERS”
The government’s case further has failed to conduct any physical examinations, nor reviewed any patients’ radiographs, reviewed any prescribing practitioners progress reports, pathology reports, blood work, nor have they conducted any reexaminations of any practitioners medical procedure to support their claim of the illegitimacy of the prescribing practitioner’s diagnosis.
Walmart points out liability for overproduction and overprescribing of opioids should fall elsewhere.
“Blaming pharmacists for not second-guessing the very doctors [the Drug Enforcement Administration] approved to prescribe opioids is a transparent attempt to shift blame from DEA’s well-documented failures in keeping bad doctors from prescribing opioids in the first place,” Walmart said in a statement last year after the US Justice Department filed a separate lawsuit against the company.
“The Justice Department’s investigation is tainted by historical ethics violations, and this lawsuit invents a legal theory that unlawfully forces pharmacists to come between patients and their doctors, and is riddled with factual inaccuracies and cherry-picked documents taken out of context. Blaming pharmacists for not second-guessing the very doctors DEA approved to prescribe opioids is a transparent attempt to shift blame from DEA’s well-documented failures in keeping bad doctors from prescribing opioids in the first place,”
DEA IS CENTER TO ILLEGAL OPIOIDS NOT WALMART, CVS, EAGLE GIANT OR WALGREENS
“U.S. taxpayers spent $8.6 billion on eradication, counter-narcotics, and “alternative” economic development campaigns, but opium production in Afghanistan soared during most of the U.S. occupation. Opium production increased by 37 percent between 2019 and 2020 alone, and the area under cultivation was one of the largest ever recorded, according to the United Nations. Like the global drug war, experts say the drug war in Afghanistan only made heroin and opium more lucrative for warlords and traffickers — including the Taliban.”
YOUR DOCTOR AND PHARMACIST ARE SIMPLY EASIER ENFORCEMENT TARGETS FOR THE DEA
As the drug dealers became more politically and technology savvy, the funding, and organizational willpower declined. Several agents were caught working for drug lords. The DEA lost its way. Much of their efforts were arresting low-level, American drug dealers have failed.
According to the Special Inspector General For Afghanistan Reconstruction, John Sopko (SIGARS) report:
“Increased interdiction operations later proved unsustainable because they had depended on the temporary influx of troops. Specialized Afghan counter-drug units developed promising capacity, but were hindered by corruption within the larger judicial system and lack of high-level support from the Afghan government.”
However, the DEA can and no longer stop the flow into this country. They can no longer fight and reduce the major drug trafficking within the United States because the DEA are culprits in trafficking by turning their heads the other way.
JUSTICE DEPARTMENT PROSECUTION OF DOCTORS ARE AN EXAMPLE OF MASSIVE GOVERNMENT OVERREACH
At the time of the DEA creation, the good intentions of this newly formed agency focused on the well-organized international drug trafficking syndicates. However, as the years passed, efforts of this arm of law enforcement have morphed into attacking and arresting American medical professionals by redefining medical procedures and misclassifying narcotic medication schedules.
We know, for example, MMED is enormously harmful as a one-size-fits-all criterion for public policy, which is precisely how the revision writers have used it. MMED is further a classic example of massive government overreach using unscientific protocols and assumptions.
“The central measure of value assumed by the CDC draft writers is still a reduction in Morphine Milligram Equivalent Dose (MMED). But it is now known from multiple sources — including a June 2021 FDA workshop — that this measure is unsupported by the medical literature.
SINCE WHEN DOES LAW ENFORCEMENT DICTATE, TREAT AND REDEFINE MEDICAL PROTOCOLS
Robert Higdon Jr., U.S. Attorney for the Eastern District of North Carolina, said in a statement that his own district has been devastated by addiction and abuse – and that Walmart only made things worse.
He further erroneously stated:
Our office prosecuted a physician for illegal opioid distribution,” Higdon said. “A jury convicted him just last year, and he is currently serving a twenty-year prison sentence. As it turns out, that physicians expressly directed patients to Walmart to have their opioid prescriptions filled. Walmart’s own pharmacists reported concerns about the doctor up the corporate chain, but for years, Walmart did nothing—except continue to dispense thousands of opioid pills.”
Addiction and abuse are medical disease states which require medical life-long treatment and since when has it become the job of law enforcement to treat a disease state.
THE DASGUPTA, BELETSKY, CICCARONE PROTOCOLS
In recasting pain as a broader condition that includes economic and social disadvantage, we urge an alternative explanation for the rising demand for opioids. It has been observed that people somaticize social disasters into physical pain. Subjective economic hardship was associated with new-onset low back pain following the Great East Japan Earthquake.48
Intensifying substance use may be a normal societal response to mass traumatic events, especially when experienced by people in lower socioeconomic strata. Increased alcohol use and binge drinking were noted after Hurricanes Katrina and Rita, with the greatest compensatory drinking among those with lower lifetime income trajectories.49 Women experiencing work stressors after September 11, 2001, were more likely to have increased alcohol use.50
Longitudinal housing relocation studies suggest that drug use improves when people move to neighborhoods with less economic disadvantage.51 Adverse childhood experiences have been strongly linked to subsequent substance use; likewise, childhood trauma is associated with increased opioid use years later.52
People who use heroin in a deindustrialized steel production area of Pennsylvania cited economic hardship, social isolation, and hopelessness as reasons for drug use, explicitly calling for jobs and community reinvestment to stem overdoses.53 Yet, some communities’ protective family54 and social structures generate resilience that mitigates negative impacts from the collision of economic hardship, substance use, and depression.55
Collectively, these observations challenge us to expand our conceptualizations of the opioid crisis beyond the vector model. A seminal National Academy of Sciences report provides this summary:
“overprescribing was not the sole cause of the problem. While increased opioid prescribing for chronic pain has been a vector of the opioid epidemic, researchers agree that such structural factors as lack of economic opportunity, poor working conditions, and eroded social capital in depressed communities, accompanied by hopelessness and despair, are root causes of the misuse of opioids and other substances.” 56(p1–9)
FOR NOW, YOU ARE WITHIN
48. Yabe Y, Hagiwara Y, Sekiguchi T, et al. Influence of living environment and subjective economic hardship on new-onset of low back pain for survivors of the Great East Japan Earthquake. J Orthop Sci. 2017;22(1):43–49. Crossref, Medline, Google Scholar
49. Cerdá M, Tracy M, Galea S. A prospective population-based study of changes in alcohol use and binge drinking after a mass traumatic event. Drug Alcohol Depend. 2011;115(1–2):1–8. Crossref, Medline, Google Scholar
50. Richman JA, Wislar JS, Flaherty JA, Fendrich M, Rospenda KM. Effects on alcohol use and anxiety of the September 11, 2001, attacks and chronic work stressors: a longitudinal cohort study. Am J Public Health. 2004;94(11):2010–2015. Link, Google Scholar
51. Linton SL, Haley DF, Hunter-Jones J, Ross Z, Cooper HLF. Social causation and neighborhood selection underlie associations of neighborhood factors with illicit drug-using social networks and illicit drug use among adults relocated from public housing. Soc Sci Med. 2017;185:81–90. Crossref, Medline, Google Scholar
52. Quinn K, Boone L, Scheidell JD, et al. The relationships of childhood trauma and adulthood prescription pain reliever misuse and injection drug use. Drug Alcohol Depend. 2016;169:190–198. Crossref, Medline, Google Scholar
55. Caetano R, Vaeth PA, Mills B, Canino G. Employment status, depression, drinking, and alcohol use disorder in Puerto Rico. Alcohol Clin Exp Res. 2016;40(4):806–815. Crossref, Medline, Google Scholar
56. National Academies of Sciences, Engineering, and Medicine. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: National Academies Press; 2017. Google Scholar