BY
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 THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WALTER F. WRENN III., MD., JULIE KILLINGWORTH, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., RICHARD KAUL, MD., 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
EXCERPTS SUPPORTING ABSTRACT
HOW DOJ-DEA IS DEFRAUDING THE AMERICAN HEALTHCARE SYSTEM
CATHLEEN LONDON, MD 3RD YEARS LAW U. MAINE WRITES:
The PDMPs are criminal and regulatory surveillance tools dressed up as public health.[47] They are used to help the DEA identify who they perceive might be suspicious patients, prescribers, and pharmacists who they feel might be diverting narcotics.[48]
“Prescription drug monitoring has exacerbated, rather than mitigated the overdose crisis. Some patients may choose to forgo treatment due to unwanted surveillance and law enforcement involvement. Monitoring incentivizes physicians to avoid these substances, even when medically indicated, to avoid scrutiny as they fear the DEA. Prescription drug monitoring has led to a dramatic spike in illicit drug use and overdoses.
“Exponential growth in overdose deaths.
The data analytics in PDMPs perpetuate biases and have a disproportionate impact on the underprivileged. Most concerning is that law enforcement can access and mine data without individualized suspicion, probable cause, or any judicial review. This has led to the inappropriate targeting of prescribers.
The PDMPs are criminal and regulatory surveillance tools dressed up as public health.[47] They are used to help the DEA identify who they perceive might be suspicious patients, prescribers, and pharmacists who they feel might be diverting narcotics.[48]
FROM THOMAS F. KLINE, MD Ph.D.:
WATCH BELOW VIDEO THE ALGORITHMS OF FRAUD
PDMP IS A LAW ENFORCEMENT TOOL DEFRAUDING THE AMERICAN HEALTHCARE SYSTEM
FROM THE LONDON BRIEFS:
Leo Beletsky of Northeastern calls the government crackdown on prescribers getting low-hanging fruit. The DEA measures success based on the number of arrests and prosecutions. Doctors are minor players. 263 physicians were convicted by the DEA on charges between 2003-2017, and over 3000 were forced to surrender their licenses.
Data mining billing records and prescription databases have become the hunting ground. The DOJ has partnered with insurance companies to share data.
a) They create their own targets. Who is the biggest prescriber in a region, state, and nationwide?
b) They are investigated. Who does the most procedures?
They use ‘flags’ like distance traveled forgetting that by disincentivizing and terrorizing prescribers there is no one left to prescribe, and patients must travel farther for the same services.
The flags created during the pill mill era are now self-perpetuating. If you mine data enough you might find something and law enforcement can access data without individualized suspicion, probable cause, or any judicial review.
THE BAMBOO BAMBOOZLE
FROM MIKE LUDWIG, TRUTHOUT MAGAZINE:
Since 2010, states have set up databases tracking controlled-substance prescriptions from the doctor’s office to the patient’s home address.
Bamboo Health, a company formerly known as Appriss, combined Prescription Drug Monitoring Databases (PDMPs) with a plethora of personal health data to develop Narxcare, an artificial intelligence system designed to alert doctors to “drug-seeking” patients and those at risk of overdose.
Reporting for Wired, journalist Maia Szalavitz revealed how Narxcare’s algorithms have a “disparate impact” on women and people of color, singling out those with complex health needs and histories of trauma and even sexual abuse.
According to the algorithm, trauma puts patients at higher risk of addiction, but advocates say prescribing decisions should be made by doctors and patients, not AI.
Bamboo Health says its algorithms are not discriminatory, and the company clashed with Szalavitz after she reported that Appriss controls criminal records data that may be built into Narxcare, which could implicate people of color who are more likely to be targeted by police.
Regardless, experts say the effects of prescription surveillance are mixed. While PDMPs are associated with fewer prescription opioid-related overdoses in some states, the decrease is offset by an increase in deaths from heroin, according to Wakeman and other researchers.
PDMPs do not address the “underlying social and political forces” that contribute to addiction and overdose, Wakeman wrote, and could push patients into the illicit drug market.
FROM YOU ARE WITHIN THE NORMS:
HOW PATIENT PHARMACIST-PATIENT PROFILING IS BEING PERMITTED TO OPERATE BY DEA-DOJ AND STATE REGULATORY BOARDS
VIDEO 1.
VIDEO-2
FROM THOMAS F. KLINE, MD Ph.D.:
THE ROLE OF THE PHARMD PHYSICIAN WANT TO BE
Two doctors recently indicted who have run a pain clinic for decades were under investigation for four years.
One was indicted over two prescriptions for a moderate number of opioids. “Numbers alone can’t determine whether a crime has been committed: The ‘normal’ amount of opioid prescribing for a physician treating pain or addiction will inevitably be much higher than the average for all doctors or the typical amount in most other specialties.”
No simple change in prescribing can alleviate all risks while properly managing patients and their pain. “Review of the evidence showed very little data on the efficacy of any of the mitigation strategies against opioid diversion and misuse including screening tools, PDMP data, UDS (urine drug screens), contracts.”
Despite the lack of evidence, the DEA and DOJ continue to insist that physicians who do not do each of these things are instead ‘pill mill’ doctors.
RICHARD LAWHERNS et., al. have written:
” Published CDC data reveal that there is no relationship between rates of opioid prescribing and rates of opioid-related overdose mortality on a US State-by-State basis. Age cohort demographics also directly contradict any medical model for cause and effect between prescribing and overdose mortality.
Seniors over age 62 are prescribed opioids three to six times more often than youth under age 19. Yet overdose-related mortality in youth is three to six times higher than in seniors over age 62 Mortality in seniors has remained relatively stable at the lowest levels in any age group, while opioid-associated morality has skyrocketed in youth during the past 20 years. (21)(22)
FROM THE LONDON BRIEFS:
THE STORY OF CHRISTOPHER RUSSO MD
Christopher Russo, MD, a physician who has been on home arrest for over 3 years since his indictment, at which time the clinic he was employed by was shut down by prosecutors. Agents and prosecutors do not understand how medicine works.
“[I]t’s easier to find ‘drug dealers with a pen’ if you simply define dealing as prescribing more than a certain amount—and busting doctors is certainly less risky for officers than going after violent cartel kingpins who run the fentanyl trade.”
He is accused of billing fraud, but he properly billed for a procedure that was done on multiple sites of the spine. Medical coding is quite convoluted. Physicians first must bill a code for the first procedure and then if they do more procedures the same day there is a different code – which is precisely what this physician did.
He then prescribed a prescription for hydrocodone for the patient following the procedure (ablation) as discomfort from nerve ablation is common.
The indictment accuses him of not only fraudulent billing but also prescribing without a legitimate medical purpose. This is typical of the indictments. Meanwhile, this fellowship-trained physician is confined to home, has no source of income, and is left with nothing.
FOR NOW, YOU ARE WITHIN
THE NORMS
REFERENCES:
1 Richard A Lawhern Ph.D. is a technically trained patient advocate and healthcare writer with 25 years experience, and ~130+ papers and articles published in a mixture of medically oriented journals and mass media.
2 Stephen E Nadeau, MD is affiliated with research Service and the Brain Rehabilitation Research Center, Malcolm Randall VA Medical Center, and the Department of Neurology, University of Florida College of Medicine. Positions offered in this paper may not reflect those of the Veterans Affairs Department or the University of Florida College of Medicine.
3 Andrea Trescot MD is a past President of the American Society for Interventional Pain Physicians. Positions offered in this paper may not reflect those of ASIPP.
4 NCIPC BSC Opioid Workgroup Report, July 2, 2021, Submitted to the July 16, 2021 Public Meeting, available at https://www.cdc.gov/injury/pdfs/bsc/OWG-Report-of-Recs-1-12-06.30.21-FINAL-508.pdf
5 Pat Anson, “CDC Advisory Panel Warns Revised Guideline Ignores Benefits of Opioids”, Pain News Network, July 16, 2021, https://www-painnewsnetwork-org.cdn.ampproject.org/c/s/www.painnewsnetwork.org/stories/2021/7/16/advisory-panel-warns-cdc-revised-opioid-guideline-ignores-risk-of-undertreating-pain?format=amp&fbclid=IwAR14Fwe7CSSxdri5Oq5NNhWb8ymooMYQ-6qAYne_yLqevR251T93_sgFSA8
6 James L. Madera, MD, CEO American Medical Association, public letter to Debra Dowell, MD, “Re:Docket No. CDC-2020-0029”, June 16, 2020, https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2020-6-16-Letter-to-Dowell-re-Opioid-Rx-Guideline.pdf
7 Jack Deutsch, “AMA Backs Update to CDC Opioid Prescribing Guidelines”, American Medical Association Press Release, July 22, 2021, https://www.ama-assn.org/press-center/press-releases/ama-backs-update-cdc-opioid-prescribing-guidelines?utm_source=twitter&utm_medium=social_ama&utm_term=5205422460&utm_campaign=Advocacy&utm_effort=FBB009&fbclid=IwAR0MXqGu-9L0lguqSgNu7TgDoLWd4baZRGGXLoy2v-rFyK_eV0NyhYJ60NE
8 NCIPC Board of Scientific Counselors, “Meetings, Minutes, and Documents” last accessed July 30, 2021 https://www.cdc.gov/injury/bsc/meetings.html
9 Richard A Lawhern, Ph.D. “Stop persecuting doctors for legitimately prescribing opioids for chronic pain”, STAT News, June 28, 2019, https://www.statnews.com/2019/06/28/stop-persecuting-doctors-legitimately-prescribing-opioids-chronic-pain/comment
10 Jeffry Singer, MD, “Evidence Pours More Cold Water on the False Narrative that Prescriptions Caused the Opioid Crisis”, Cato at Liberty, November 20, 2019, https://www.cato.org/blog/evidence-pours-more-cold-water-false-narrative-prescriptions-caused-opioid-crisis
11 Steven E Nadeau, MD, Jeffry K Wu, and Richard A Lawhern, PhD, “Opioids and Chronic Pain: An Analytic Review of the Clinical Evidence”, Journal of Medicine, National College of Physicians, March 1, 2021.
12 Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and geographic patterns in drug and synthetic opioid overdose deaths — United States, 2013-2019. MMWR Morbidity and Mortality Weekly Report. 2021;70(6):202-7).
13 Jacob James Rich and Robert Capodilupo “Prescription Drug Monitoring Programs: PDMP Effects on Opioid Prescribing and Drug Overdose Mortality.” Reason Foundation, July 2021, https://reason.org/wp-content/uploads/prescription-drug-monitoring-programs-effects-on-opioid-prescribing-and-drug-overdose-mortality.pdf
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14Jeffrey A. Singer, MD, “If Lawmakers Really Want to ‘Follow the Science’, They Will Repeal Codified Opioid Guidelines”. Cato At Liberty, May 24, 2021. https://www.cato.org/blog/lawmakers-really-want-follow-science-they-will-repeal-codified-opioid-guidelines
15 Josh Bloom, PhD, “Comments to the FDA – Opioid Dosing Based on Milligram Morphine Equivalents is Unscientific”, American Council on Science and Health, May 24, 2021, https://www.acsh.org/news/2021/05/24/comments-fda-opioid-dosing-based-milligram-morphine-equivalents-unscientific-15561
16 Sally Satel, MD, “The Truth About Painkillers” National Affairs, Nr 47, Spring 2021. https://nationalaffairs.com/publications/detail/the-truth-about-painkillers
17Tom Lynch, Amy Price, “The Effect of Cytochrome P450 Metabolism on Drug Response” Am Fam Physician. 2007 Aug 1;76(3):391-396. https://www.aafp.org/afp/2007/0801/p391.html
18 Donna J. Belle and Harleen Singh, “Genetic Factors in Drug Metabolism”, Am Fam Physician. 2008 Jun 1;77(11):1553-1560 https://www.aafp.org/afp/2008/0601/p1553.html
19 Andrea M. Trescot, MD, and Semyon Faynboym, MD “A Review of the Role of Genetic Testing in Pain Medicine”, Pain Physician 2014:17 ISSN 1533-3159
20 Bhushan A Kapoor, Prateek Lala, Julie L.V. Shaw, “Pharmacogenics and Chronic Pain Management” Clinical Biochemistry, 2014. http://dx.doi.org/10.2016/j.clinbiochem.2014.05.065
21 Richard A. Lawhern, PhD, “Tracking Down the ‘Research’ Behind The CDC’s Opioid Prescribing Guidelines”, National Pain Report, August 10, 2016. http://nationalpainreport.com/tracking-down-the-research-behind-the-cdcs-opioid-prescribing-guidelines-8831122.html
22 Richard A. Lawhern, “The Opioid Crisis in Three Charts” – May 2021, http://face-facts.org/lawhern/the-opioid-crisis-in-three-charts/
23 Skelly AC, et al. Noninvasive nonpharmacological treatment for chronic pain: a systematic review. Prepared for AHRQ, HHS, Publication No.18-EHC013-EF, Rockville, MD, June 2018. https://effectivehealthcare.ahrq.gov/products/nonpharma-treatment-pain/research-2018
24 Richard A Lawhern, PhD and Steven E Nadeau, MD, “Behind the AHRQ Report – Understanding the limitations of “non-pharmacological, non-invasive” therapies for chronic pain.” Practical Pain Management, Vol 18, Issue #7, October 3, 2018.
25Jeffrey A Singer MD, Jacob Z Sullum, Michael E Schatman PhD, “Today’s nonmedical opioid users are not yesterday’s patients; implications of data indicating stable rates of nonmedical use and pain reliever use disorder” Journal of Pain Research,V12:617-620, https://www.researchgate.net/publication/330922982_Today’s_nonmedical_opioid_users_are_not_yesterday’s_patients_implications_of_data_indicating_stable_rates_of_nonmedical_use_and_pain_reliever_use_disorder
26 Nadeau SE. Opioids for chronic nonmalignant pain. To prescribe or not to prescribe—what is the question? Neurology. 2015;85:646-51)
27 Jennifer P Schneider MD, PhD, “Editorial: Why are ER Opioids Out of Favor?” Practical Pain Management, Volume 20 Issue #3, June 18, 2020
28 Bohnert, A.S.B., Valenstein, M., Bair, M.J., Ganoczy, D., McCarthy, J.F., Ilgen, M.A., et al. (2011). “Association between opioid prescribing patterns and opioid overdose-related deaths.” JAMA 305, 1315-1321.
29 Gomes, T., Juurlink, D.N., Dhalla, I.A., Mailis-Gagnon, A., Paterson, J.M., and Mamdani, M.M. (2011). Trends in opioid use and dosing among socio-economically disadvantaged patients. Open Med 5, 13-22.
30 Dominique Mosbergen, “Tylenol Overdose Risk is Staggering; Acetaminophen Safeguards Remain Insufficient” Huff Post updated December 6, 2017
31 Josh Bloom, PhD., “Need General Surgery? Ignore the Surgeon General”, American Council on Science and Health, July 8, 2019 https://www.acsh.org/news/2019/07/08/need-general-surgery-ignore-surgeon-general-14135
32 Josh Bloom, PhD, “Tylenol is Not so Safe, but At Least it Works, Right?” American Council on Science and Health, September 18, 2017,
“In reality, Tylenol doesn’t work very well at all, and there is plenty of evidence to back this up, especially in systematic Cochrane Reviews – highly regarded, evidence-based reviews that carefully evaluate the quality of data in multiple studies.”
33 Alparslan Turan, MD; Hani Essber, MD; Wael Saasouh, MD et al, “Effect of Intravenous Acetaminophen on Postoperative Hypoxia After Abdominal Surgery – The FACTOR Randomized Clinical Trial” JAMA. 2020;324(4):350-358. doi:10.1001/jama.2020.10009
34 Roger Chou, et al, “Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review”, Agency for Healthcare Research and Quality, June 11, 2018. https://effectivehealthcare.ahrq.gov/products/nonpharma-treatment-pain/research-2018
35 Roger Chou, MD, Jesse Wagner, et al, “Treatments for Acute Pain: A Systematic Review” [Comparative Outcomes Review Number 240] Agency for Healthcare Research and Quality, December 2020https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-240-acute-pain-review.pdf
36 Ibid Lawhern and Nadeau, 2018
37 Janel Miller, “Opioid Tapering Significantly Increases Risk of Overdose, Mental Health Crisis” Helio, August 3, 2021. https://www.healio.com/news/primary-care/20210803/opioid-tapering-significantly-increases-risk-for-overdose-mental-health-crisis
38 Sean Mackey MD, Dan Carr, MD, Richard Steig MD, Lynn Webster MD, Chad Kollas MD, Bob Twillman, PhD, “RE Health Evidence Review Commission, Chronic Pain Task Force Revised Proposal”, Letter to the Honorable Kate Brown, Governor of Oregon, December 4, 2018.
39Chad Kollas, MD, “PROP’s Disproportionate Influence on U.S. Opioid Policy: The Harms of Intended Consequences Palimed – A Hospice and Palliative Medicine Blog. June 2021.
https://www.pallimed.org/2021/05/props-disproportionate-influence-on-us.html#disqus_thread
And I worry for all of the wounded from the recent tornadoes cut with glass or wood or sharpened pieces of metal that got nothing when the morphine ran out due to production cut-backs based on this foundationless hysteria regarding the relatively rare “addiction”. The word is still being severely misused by unqualified authorities.