MORPHINE: THE MOST IMPORTANT MEDICATION, A CRITICISM, AND REJECTION OF LOYOLA MARYMOUNT LAW PROFESSOR REBCAA DELFINO, ESQ, “PAPA,” AS “EMPTY BAG LEGISLATION”-PRT-3

re-published and reported by youarewithinthenorms.com

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

Part-3 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 and Part-2

THE MOST IMPORTANT MEDICATION IS MORPHINE

While it can be argued that all medication is important, I believe the most important medication is Morphine. Because drugs containing the morphine molecule have been blamed for addiction and drug overdose deaths, the value and life-saving properties have been overlooked.

Millions of individuals have survived traumatic injuries and can carry out their activities of daily living. If looked at honestly, the benefits far outway the few instances of addiction (1%) and overdose deaths.

FAMILY PUB NIGHT RECCA DELFINO, ESQ  ON MORPHINE

PAPA IS A BRAND-NEW EMPTY BAG

Stop demonizing opiates because some individuals  CHOOSE to abuse substances that lead to their death. Remember, 450,000 people die from tobacco-related causes and 100000 from alcohol-related causes.

Walter F. Wrenn,III,M.D.

PART-3

EXCERPTS FROM YALE LAW AND POLICY REVIEW

SPRING 2023

INTER ALIA

The Misinformed & Misguided Prescription Abuse Prevention Act: A Response to Delfino

Tuesday, February 7, 2023 – 10:45a

*Robert Capodilupo & Jacob James Rich*

“Our criticisms of PAPA, however, should not be taken as an endorsement of the current regime under the CSA. We agree with Delfino that the “[p]rosecution of doctors under the federal CSA has been problematic in several respects.”^[72] 

However, this is because the CSA has made it more difficult for doctors to provide legitimate opioid treatments for patients out of fear of prosecution. As such, instead of abandoning the CSA regime, we recommend reforming it—specifically through adopting a more capacious definition of what constitutes a “legitimate medical purpose.”^[73] 

Oyez! Oyez! Oyez!

The Honorable, the Chief Justice, and the Associate Justices of the United States Supreme Court. All persons having business before the Honorable the Supreme Court of the United States are admonished to draw near and give their attention, for the Court is now sitting.

“This appears to be the path taken by the Supreme Court in the recent case, XiuluRuan v. United States. There, the Court interpreted the CSA’s prohibition on doctors “knowingly” dispensing opioids outside of the “usual course of his professional practice” to mean that, in order to face liability, doctors must know the prescription was outside of the usual course of practice, rather than simply know he was prescribing the substance.^[74] 

This interpretation may work towards reducing the chilling effect discouraging opioid treatments, as physicians can only face liability under the CSA if the government can “prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner.”^[75]

Still, long-term maintenance of patients on opioids—especially illicit opioids like heroin—is still considered to be outside “the usual course of professional practice” and thus remains an unauthorized procedure prohibited by the CSA.^[76] Maintaining those suffering from addiction on opioid regimes is considered a legitimate practice in many other countries.^[77] 

For example, qualifying physicians in Canada are allowed to prescribe long-term regimens—and even pharmaceutical-grade heroin—to “people who are severely addicted to opioids.”^[78] The logic behind these programs follows from the idea that the harms of drug use will be reduced if a user can acquire the substance legally.^[79] 

Recognizing that many people who are highly addicted to opioids are going to seek out these drugs regardless of legality,^[80] these programs seek to reduce the harms of drug use by ensuring that users are given an unadulterated substance.

In the United States, legalizing heroin-assisted treatment would require both a rescheduling of heroin from Schedule 1 to Schedule 2, and an agency reinterpretation of the CSA to recognize this practice as legitimate.^[81] In turn, reforming the CSA to allow for heroin-assisted treatment would likely have a significant effect on reducing overdose deaths in the United States.

As one review of the outcomes of heroin-assisted treatment in Europe concludes, these programs are associated with “substantial improvement in health and well-being of the patients … [including] a major reduction in the extent of continued injecting of ‘street’ heroin, improvements in general health, psychological well-being and social functioning, as well as major disengagement from criminal activities.”^[82] 

And, crucially, heroin-assisted treatment is associated with “reductions in illicit heroin use,” suggesting that users are at a decreased risk for overdoses caused by laced substances.^[83]

The current nature of the opioid crisis demands solutions that recognize the nuances of the situation. PAPA would only perpetuate the current failed approach by incentivizing the use of black-market opioids, the principal driver of overdose deaths. Instead of limiting access to legal opioids, public policy should be working towards expanding the extent to which opioid users can continue to be treated by physicians in a safer, supervised manner.

Amending the CSA to allow for the expansion of legal, legitimate maintenance treatment, rather than increasing the scrutiny of prescribing in an imprecise and ambiguous manner, poses the best policy framework for reducing the harms of opioid use.

FOR NOW, YOU ARE WITHIN

THE NORMS

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