FROM THE NEW YORK TIMES MARCH 22, 2024: “THE D.E.A. NEEDS TO STAY OUT OF MEDICINE” BY DR. SHRAVANI DURBHAKULA, MD, A PAIN MEDICINE PHYSICIAN FROM NASHVILLE & LYRICS FROM BIGGY SMALLS-NEW YORK IDENTIFYING D.E.A. -CORRUPTION

“…And Carl Nelson, This Ain’t News???…”

DEA:”..THE POWER TO IGNORE THE LAW..” CONGRESSIONAL OVERSIGHT NEEDED

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., EVELYN J. CLEMENT, 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

reposted: from new york times march 22, 2024, 5:05 a.m. et

THANK YOU SO MUCH DR. S. DURBHAKULA: THE WAR ON DRUGS IS A WAR ON PAIN PATIENTS

PAIN CARE AND WOMEN’S REPRODUCTIVE HEALTHCARE ARE ONE IN THE SAME

It is time for the D.E.A. to stop meddling in medicine!!! Click on here the original link.

By Shravani Durbhakula
Dr. Durbhakula is an anesthesiologist and pain medicine physician from Nashville.

“Even when her pancreatic cancer began to invade her spine in the summer of 2021, my mother-in-law maintained an image of grace, never letting her own pain stop her from prioritizing the needs of others. Her appointment for a nerve block was a month away, but her pain medications enabled her to continue serving her community through her church. Until they didn’t.

Her medical condition quickly deteriorated, and her pain rapidly progressed. No one questioned that she needed opioid medications to live with dignity.

But hydrocodone, and then oxycodone, became short at her usual pharmacy and then at two other pharmacies.

My mother-in-law’s 30-day prescriptions were filled with only enough medication to last a few days, and her care team required in-person visits for new scripts. Despite being riddled with painful tumors, she endured a tortuous cycle of uncertainty and travel, stressing her already immunocompromised body to secure her medications.

“…The number of unfilled pain medicine fellowship training positions has more than doubled in the last three years, and pain physicians are leaving the specialty…”

My mother-in-law’s anguish before she passed away in July 2022 mirrors the broader struggle of countless individuals grappling with pain. I’m still haunted by the fact that my husband and I, both anesthesiologists and pain physicians who have made it our life’s work to alleviate the suffering of those in pain, could not help her. It is no wonder that our patients are frustrated.

They do not understand why we, doctors whom they trust, send them on wild goose chases. They do not understand how pharmacies fail to provide the medications they need to function. They do not understand why the system makes them feel like “drug seekers.”

Health care professionals and pharmacies in this country are chained by the Drug Enforcement Administration.

Our patients’ stress is not the result of an orchestrated set of practice guidelines or a comprehensive clinical policy but rather one government agency’s crude, broad-stroke technique to mitigate a public health crisis through manufacturing limits — the gradual and repeated rationing of how much opioids can be produced by legitimate entities. This is a bad and ineffective strategy to solving the opioid crisis, and it’s incumbent on us to hand the reins of authority over to public health institutions better suited to the task.

Since 2015, the D.E.A. has decreased manufacturing quotas for oxycodone by over 60 percent and for hydrocodone by about 72 percent.

D.E.A.; THE FEDERAL GOVERNMENT MAFIA GANGSTERS!!

“..Still, some health care providers are reluctant to prescribe them, even for cancer pain where opioids are a mainstay of treatment..”

Despite thousands of public comments from concerned stakeholders, the agency has finalized even more reductions throughout 2024 for these drugs and other commonly prescribed prescription opioids. In theory, fewer opioids sold means fewer inappropriate scripts filled, which should curb the diversion of prescription opioids for illicit purposes and decrease overdose deaths — right?

I can tell you from the front lines that’s not quite right. Prescription opioids once drove the opioid crisis. But in recent years, opioid prescriptions have significantly fallen, while overdose deaths have been at a record high. America’s new wave of fatalities is largely a result of the illicit market, specifically illicit fentanyl.

And as production cuts contribute to the reduction of the already strained supply of legal, regulated prescription opioids, drug shortages stand to affect the more than 50 million people suffering from chronic pain in more ways than at the pharmacy counter.

Doctors may be forced to ration medications or choose which patients out of a qualifying group actually receive scripts, and drug prices may increase for consumers. In an aging population with increasing pain medication needs, more patients may struggle more frequently to fill prescriptions that treat their pain, and because of known treatment biases in pain medicine, women and people of color could be disproportionately affected, widening existing disparities.

Paradoxically, the D.E.A.’s production cuts may drive patients to seek opioids on the illicit market, where access is easy. Still, drugs are laced unpredictably with fentanyl, xylazine, and other deadly synthetics.

My patients confide that they cannot go through cycles of pain relief and withdrawal and cannot spend hours in the emergency room; in their minds, they have no choice but to turn to the streets.

We’ve seen this play out before. When the D.E.A. made legal access to products containing hydrocodone more difficult in 2014, the sale of opioids through online illicit markets increased to 13.7 percent of all drug sales from an estimated 6.7 percent, and sales shifted toward more potent opioids like fentanyl.

FROM BIGGY SMALLS MO-MONEY, MO-PROBLEMS, !lyrics!

B-I-G P-O-P-P-A
“No info for the DEA
Federal agents mad ’cause I’m flagrant
Tap my cell and the phone in the basement
My team supreme, stay clean
Triple beam lyrical dream, I be that
Cat you see at all events bent
Gats in holsters, girls on shoulders“

The D.E.A. isn’t new to these criticisms. As recently as January, it insisted that manufacturing issues or other supply-chain disruptions were the real issues limiting patient access to pain medication, not manufacturing quotas or the imposition of limits. The agency suggested that action would be taken if the Food and Drug Administration told it about shortages, which the F.D.A. hasn’t done so far.

But when more than a third of healthcare professionals attest that their patients struggle to fill opioid scripts, something is clearly not working. The D.E.A.’s responses read more like a deflection of blame than a serious strategy.

My profession makes me acutely aware of opioid risks, including addiction and overdose, but at times, and under careful dosing and monitoring, opioids are the right choice for our patients.

Still, some healthcare providers are reluctant to prescribe them, even for cancer pain, where opioids are a mainstay of treatment. Many cited opioid dispensing at pharmacies as a barrier.

DEA OUTRIGHT PROMOTES CRIMINALIZATION, PROFILING DISCRIMINATION OF SICKLE CELL DISEASE PATIENT AS RED FLAGS

“..the D.E.A., an agency staffed with law enforcement officials, is not equipped to distinguish appropriate from inappropriate prescribing..”

This is concerning since untreated pain is associated with decreased immunity, a worsening of depression, reduced mobility, and adverse effects on quality of life. Ineffective pain management has also been associated with increased medical costs.

Among people with sickle cell disease, for instance, 10 percent of patients account for 50 percent of emergency room visits. Although they suffer from other possibly contributing disorders, the common feature among them is chronic pain.

Dangerous prescription drugs require safeguards, but a scalpel has more promise than a sledgehammer. The D.E.A., an agency staffed with law enforcement officials, is not equipped to distinguish appropriate from inappropriate prescribing, and it has in the past confused inappropriate with criminal. Instead of defining medical aptness itself, the D.E.A. should pass the baton to our nation’s public health agencies.

Collaboratively, the Centers for Disease Control and Prevention, the Food and Drug Administration, and the Department of Health and Human Services can take a tailored, more precise approach to opioids that is informed by medical and clinical acumen.

The F.D.A., in particular, should strengthen existing risk evaluation and mitigation strategies programs, which place controls on individual medications and respond to signs of inappropriate prescribing. Although such programs have not always responded effectively, they can be improved with planning, time, and resources. And lastly, the government should strip the D.E.A. of its authority to suspend providers’ controlled substance licenses when dangers arise and should hand that power over to these public health agencies.

As the rates of chronic pain rise, I fear the future. Our medical students report reservations about treating pain patients, and while a dedicated medical school pain curriculum can shift attitudes, few schools offer one.

The number of unfilled pain medicine fellowship training positions has doubled in the last three years, and pain physicians are leaving the specialty. For the field to recover, the thoughtful consideration of clinicians must be empowered by our nation’s health entities.

It is time for the D.E.A. to stop meddling in medicine!!!“

___________________________________________________________

Background:

Shravani Durbhakula is an anesthesiologist and pain medicine physician. She serves on the board of directors of the American Academy of Pain Medicine Foundation. She is a former director of the pain medicine fellowship and of the medical school pain course at Johns Hopkins School of Medicine.

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