NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS MD, PH.D., IN THE SPIRIT OF 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 KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., 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 NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
FROM YALE LAW AND POLICY REVIEW
SPRING 2023
Tuesday, February 7, 2023 – 10:45a
By *Robert Capodilupo & Jacob James Rich*
Part-2 of a Three-Part Series from Robert Capilupo and Jacob James Rich’s article from the Yale Law and Policy Review, Spring 2023, refuting Loyola Marymount Law Professor Rebecca Delfino proposed policy changes in the handling of prescription Narcotic Analgesics (Opioid Medications) See Part-1
LAW PROFESSOR REBECCA DELFINO
Misinformed, Misguided, AND FREQUENTLY INCORRECT
“But most damaging to Delfino’s normative project is its incorrect statement that “[s]eventy percent of [opioid overdose] deaths involve an opioid that a doctor legally prescribed.”[31] One can only arrive at this claim by treating synthetic opioids, like fentanyl, as “legally prescribed” drugs—a practice that is rejected by the relevant literature for inaccurately representing the source of most fentanyl.[32]
According to a report published by the Centers for Disease Control & Prevention (CDC), “only a small percentage of fentanyl deaths had evidence consistent with prescription fentanyl,” while the vast majority of these deaths derive from “[i]llicitly manufactured fentanyl.”[33] By August 2017, the CDC had formally removed fentanyl from the definition of prescription opioid mortality.[34]
Moreover, to count all cases of fentanyl-overdose deaths as those caused by legally prescribed controlled substances inflates the fraction of deaths attributable to prescription opioids.[35] If policymakers want to use legislation to reduce overdose deaths, then it is critical for them to know where opioids that disproportionately lead to mortality are sourced. Prescription opioids have not accounted for a majority of opioid-overdose deaths since 2014 and have not represented a majority of total drug-related deaths since substance-specific data have been available.[36]
illicit fentanyl is the driving force behind this most recent wave of the opioid crisis
Instead, illicit fentanyl is the driving force behind this most recent wave of the opioid crisis. In fact, the CDC wrote in JAMA that fentanyl alone accounted for “nearly all the increase in drug overdose deaths from 2015 to 2016.”[37] This has held for every year following.[38]
But most damaging to Delfino’s normative project is its incorrect statement that “[s]eventy percent of [opioid overdose] deaths involve an opioid that a doctor legally prescribed.”[31] One can only arrive at this claim by treating synthetic opioids, like fentanyl, as “legally prescribed” drugs—a practice that is rejected by the relevant literature for inaccurately representing the source of most fentanyl.[32]
According to a report published by the Centers for Disease Control & Prevention (CDC), “only a small percentage of fentanyl deaths had evidence consistent with prescription fentanyl,” while the vast majority of these deaths derive from “[i]llicitly manufactured fentanyl.”[33] By August 2017, the CDC had formally removed fentanyl from the definition of prescription opioid mortality.[34]
Moreover, to count all cases of fentanyl-overdose deaths as those caused by legally prescribed controlled substances inflates the fraction of deaths attributable to prescription opioids.[35] If policymakers want to use legislation to reduce overdose deaths, then it is critical for them to know where opioids that disproportionately lead to mortality are sourced.
Prescription opioids have not accounted for a majority of opioid-overdose deaths since 2014 and have not represented a majority of total drug-related deaths since substance-specific data have been available.[36] Instead, illicit fentanyl is the driving force behind this most recent wave of the opioid crisis. In fact, the CDC wrote in JAMA that fentanyl alone accounted for “nearly all the increase in drug overdose deaths from 2015 to 2016.”[37] This has held for every year following.[38]
This outcome likely occurs because users cut off from legal channels of prescribed, quality-controlled drugs are often driven toward the black market to supplement their demand for opioids,[42] where drugs are far more dangerous.
As one account explains, “[q]uality control is poor in underground markets because . . . [c]onsumers cannot easily assess the purity of the products they consume,” increasing the likelihood that they “accidentally take high-dose drugs or versions laced with more potent opioids like fentanyl.”[43] Because of these inherent dangers of the black market, policies that unduly restrict access to legal channels of prescribing appear to exacerbate overdoses from illicit opioids—as is reflected by the rapid rise in fentanyl deaths in the wake of these policy interventions.
….richard lawhern ph.d
PROFESSOR REBECCA DELFINO FAILURE TO PROPERLY EXCLUDE FENTANYL AS A “LEGALLY PRESCRIBED” OPIOID CONSTRUCT AS FALSE PREMISE
Overall, Delfino’s failure to properly exclude fentanyl as a “legally prescribed”[44] opioid constructs a false premise that prescription opioids are the principal cause for the current wave of the opioid crisis. This mischaracterization undermines the cogency of her policy proposal and could potentially yield the devastating unintended consequence of increasing overdose deaths.”
Of central concern is that the entire conceptual framework of this fatally flawed document is centered on restrictions of Morphine Milligram Equivalent Dose. This concept is long known to be actively harmful junk science. Despite a huge body of highly critical feedback from the medical and scientific community, NCIPC continues in its stubborn and unfounded attempts to suppress prescription opioids in pain management practice.”
FOR NOW, YOU ARE WITHIN
THE NORMS
** Robert Capodilupo, Yale Law School, J.D. expected Spring 2023; M.Phil., Magdalene College, University of Cambridge, A.B. magna cum laude in Government, Harvard College. Jacob James Rich, Cleveland Clinic Center for Value-Based Care Research; Reason Foundation Drug Policy Project; Case Western Reserve University School of Medicine, Ph.D. expected Spring 2025; M.A., Eastern Michigan University; B.S., Eastern Michigan University. The Authors would like to thank Professor Jonathan H. Adler, Professor Jeffrey A. Miron, Dr. Jeffrey A. Singer, and Professor Kate Stith for their helpful feedback on earlier drafts of this Essay. The Authors are particularly grateful to Isaiah Ogren for his fantastic work on this Essay as Executive Editor for Inter Alia and to Karissa Kang and Amir Perk for demonstrating exceptional academic integrity in agreeing to publish this response.
REFERENCE:
REBECCA DELFINO, PROFESSOR OF LAW, MIS-GUIDED, MIS-INFORM, INACCURATE, AND JUST WRONG
In the case of Rebecca Delfino, Esq, from her video presentation in “Faculty Publication Night,” I’m reminded of a statement written by Paul de Kruif, 1926 in the treatment of Yellow Fever and slightly modified that describes her dilemma:
“…The stark difference between well-intentioned ignorance and understanding. Ignorance can be a killer in the hands of people with the best intentions, while knowledge can enable people to prevent or treat disease. It is often better to say nothing until that knowledge is obtained…”
…norman j. clement rph., dds“
DEA LIED TO CONGRESS
“Much like a diabetic is dependent on insulin,” Bockoff’s attorney wrote in one court filing, “taking away the controlled substances allowed only by prescription from a DEA registered physician can be life-threatening.”
EXPOSING, “THE DELFINO DECEPTIONS“
“What I learned was an eye-opening lesson. Truth doesn’t matter. What matters is what lies can one make you believe is the Truth”
I was treated like a common criminal. I legally prescribed an FDA-approved medication after examining a patient. I didn’t do anything or act in any way that was different than what I had done for more than 42 years of practicing medicine...”
…..walter f. wrenn, iii, md
OR SEND
$100, $250, $500, $1000
TO ZELLE 3135103378
OR
CASH APP:$docnorm
Will Rogers__
“The problem ain’t what people know. It’s what people know that ain’t so that’s the problem.”
She is bought and paid for. Purdue pharma destroyed my life and their bankruptcy settlement is the only one I know of that gives 94+% to the government, not the victims. The opioid crisis was ignited by FDA Chief Dr Curtis Wright who conspired with Purdue to lie about Oxycontin and perpetuated by political prostitution. No one prosecuted. This woman is an idiot or intentionally misleading the public. THE REASON SO MANY PEOPLE BECAME ADDICTED IN EARLY 2000s was because Purdue claimed oxycontin was <1% addictive and encouraged, bribed and misled doctors. The government response was ridiculous. Cutting back production after realizing the enormity of the problem without any logical plan to help victims withdraw and stabilize. Continuing to allow political prostitution (big pharma)to drive votes instead of what's best for the citizens. Making ridiculous laws regarding medication (suboxone)that would help the victims of government negligence. Women like this perpetuate the problem with ridiculous studies such as this. Shame on her.