“MAKING GOOD TROUBLE,” A LETTER TO THE PRESIDENT OF THE AMERICAN MEDICAL ASSOCIATION: MY NAME IS DR. HOWARD ADELGLASS, MD., I AM, WITH NEARLY 4000 INNOCENT MEDICAL PROVIDERS IN FEDERAL PRISON, VICTIMS OF PERSECUTION BY D.E.A.-DOJ “WAR ON PAIN CARE MEDICINE

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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., IN THE SPIRIT OF LEROY BAYLOR, JAY K. JOSHI MD., MBA,AISHA GARDNER, 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

LETTER TO THE PRESIDENT OF THE AMERICAN MEDICAL ASSOCIATION

The provided text is an excerpt from a letter written by Dr. Howard Adelglass,MD a physician incarcerated for opioid-related charges, to the president of the AMA. 

Dr. Adelglass contends that numerous doctors are unjustly prosecuted based on flawed science and biased information, leading to their imprisonment and the suffering of their patients.

He recounts his own experience, highlighting alleged prosecutorial misconduct, the misuse of CDC guidelines as law, and the reliance on algorithms that unfairly targeted physicians. 

He argues that this aggressive anti-opioid campaign has inadvertently increased illicit drug use and patient harm. Dr. Adelglass also draws parallels to historical instances of medical persecution and discusses the Ruan v. United States Supreme Court decision, suggesting that despite this ruling, innocent doctors remain imprisoned. 

Ultimately, the letter is a plea for help in addressing what Dr. Adelglass describes as a crisis of malicious prosecution against pain management physicians.

Dear Dr. Bruce Scott, MD.,

More licensed and experienced doctors will soon be thrown into prison as thousands of them have been already, and their families impoverished because they are targets of malicious prosecution using junk science. Thousands of patients are losing competent care, then suffering, even dying by their own hands, and traffic in illicit drugs has increased as a result of this anti-opioid campaign.

My name is Howard Adelglass. I am a physician that is currently incarcerated in Federal Correctional institution at Butner, North Carolina. It must seem strange to you to receive a letter from a prisoner, a medical doctor no less. However, I am hoping that you can help me and tens of thousands of people affected by what put me in prison. 

https://t.co/j62oX62s2Z

Dr. David Stein discusses the government’s use of Tim King and his non peer reviewed scientifically unproven patent he uses to convict doctors that prescribe opioids.
Junk science is prevailing in courts.

— Michael Ney (@MichaelNey19) September 8, 2023

I read your acceptance speech when you became President of the AMA and was very impressed. We share a common belief about the misguided and malicious treatment of doctors over the past few years based on fake science, biased experts, and unproven and untested algorithms used to target innocent well-meaning physicians, ruining their lives and their families’ and their patients’ lives.

When I used to read about doctors being arrested and pleading guilty for selling opioids, I assumed they were guilty because they pled guilty. I said to myself “I don’t have anything to worry about. I’m not doing anything wrong. Why should I worry?” 

I was dead wrong. I, like most people, did not understand how the federal justice system works and how easily it can be abused. In speaking to many doctors in a similar position to mine it became clear that very few of them were guilty.

They were being forced to take guilty pleas as they were over 60 years of age, were Black, Asian, Hispanic, Jewish, or were foreign medical school graduates. They were threatened with over 20 years in prison, loss of all their assets, and arrest of their family.

With the cost of defending oneself in litigation between $100,000 and over a million dollars, they had no choice but to plead guilty and accept lesser charges. I was not guilty of anything but trying to help my patients, and wouldn’t even discuss a plea with my defense counsel.

But cases that go to court are won by the prosecution 99% of the time, as the court is rigged against public defenders who have too many cases and don’t have the manpower to put up an adequate defense.

STRUCTURE OF THIS LETTER

1.  WHO I AM

2.  HOW MY PAIN PRACTICE WAS MULTIMODAL/MULTDISCIPLINARY

3.  THE MOST SHAMEFUL CAMPAIGN IN THIS “WAR ON DRUGS”

4.  FOIA INFORMATION

5.  THIS HAS HAPPENED BEFORE

6.  MY CASE IS TYPICAL

7.  RESULTS – NEEDLESSLY SUFFERING AND DYING PATIENTS

8.  RESULTS – IMPRISONED DOCTORS

9.  RUAN V. UNITED STATES – SCOTUS DECISION

10.  CONCLUSION

1.  WHO I AM

I would like to tell you a little about myself. I am 69 years old. I will spare you my medical history except to say that I suffer from moderate to severe deafness, and have Wegener’s Granulomatosis.

I had three ear drum transplants 30 years ago which didn’t take, and I had a myringotomy tube put in my other ear six years ago at the onset of my Wegener’s. I only mention this because my deafness causes me to speak loudly, and tapes played in court and talking with my lawyer were misinterpreted as “screaming.” My lawyer only explained this to the judge after the trial.

I graduated from The Autonomous Universidad of Guadalajara in 1980. I did a one-year Fifth Pathway, a rotating clinical clerkship, at Nassau Hospital in Mineola, New York, now known as Winthrop/Langone University Hospital, a NYU affiliate. During my Fifth Pathway, I became certified in hypnosis and licensed in acupuncture.

My acupuncture number in New York was 340, and my American College of Acupuncture number was 25. I am probably the oldest living white acupuncturist in America.

My residency was in Physical Medicine and Rehabilitation at the Rusk Institute/Belview/NYU Medical Center (Lagone), and the Manhattan Veterans Administration. My last year I was a chief resident and won an award for medical research. I published three articles and presented a poster at the Second International Pain Conference in Seattle.

I served for one year on the New York State Board of Sports Medicine and School Health.

In 1984 I was the first Pain Fellow at the Hospital For Joint Disease/Orthopedic Institute (a NYU teaching hospital.) During my fellowship, I rotated through the departments of Anesthesiology, Behavioral Medicine, Radiology, Physical and Occupational Therapy, Rheumatology, and Orthopedics, and worked in one of the few and the longest lasting inpatient pain programs in the country.

Prior to my fellowship, I spent two months working with Hans Krauss, the doctor for JFK and considered to be the inventor of trigger point injections, and the father of Sports Medicine.

Subsequently I ran the Outpatient Pain Clinic at the Hospital for Joint Disease/Orthopedic Institute for 15 years. While at the Hospital I evaluated and treated all the inpatient chronic pain patients that were in a multidisciplinary chronic pain program. This was the only multidisciplinary inpatient pain program in America at that time, and the oldest one in America until it closed.

These multidisciplinary programs couldn’t exist any longer because the insurance companies wouldn’t pay for them any more. With my new skills I was multidisciplinary, and a number of these patients continued seeing me until I was arrested.

During that time I was a clinical instructor, then a clinical assistant or Associate Professor of Rehab Medicine at NYU, until a few years after I left the Hospital. While on faculty, I had NYU Mount Sinai residents as well as residents from many other rehabilitation residency programs do electives in my office to learn my techniques.

I was the Medical Director for Arthro-Fitness for three years, an outpatient rehab clinic specializing in arthritis and traumatic injuries. Arthro-Fitness was affiliated with NYU and New York Sports Club, which was inside of one of the New York Sports Club’s facilities.

Over the years I gave many grand rounds and lectures on various pain management subjects in academic and nonacademic settings. I gave a lecture at Mount Sinai Medical Center on facet blocks, and led a roundtable discussion with Dr. Janet Travel and Dr. Hans Kraus, both doctors of JFK and pioneers of trigger point treatment, the first time they talked in more than 20 years.

In 1986 I worked for the Long Island Railroad and subsequently became the Medical Director. While there I helped set up a work-hardening program and a back school for injured railroad workers. These programs returned injured workers back to work sooner and with fewer reoccurrences of their injuries.

In 1988 I became the Director of the Rehabilitation Medicine at JFK Airport in the Department of Occupational Medicine at the Catholic Medical Center of Brooklyn and Queens, which encompassed five hospitals, and I had five doctors reporting to me. I was also in charge of Long Island Jewish’s EMG training for their residency program.

My group set up a mobile hospital to detect and house drug traffickers, and my chairman won an award as Interpol Man of the Year for this project. I subsequently became the Director of Rehabilitation Medicine at the Jewish Hospital EMG. For over ten years I was the Rehabilitation Director of four nursing homes.

I was the Rehab Director of Terrance Cardinal Cooke Home and Hospital for 15 years, seeing patients in their Cerebral Palsy, Brace/Scoliosis, and General Rehabilitation Clinics, as well as patients in the AIDS, Huntington’s Chorea clinics, Dialysis, and general nursing Home units.

For ten years I was the Rehabilitation Medicine Director of UNITE, the first female workers’ union in America. UNITE was founded for garment center workers after the Triangle Shirt Factory fire in the early 1900s.

During my fellowship and afterwards I took many courses from the Michigan State College of Osteopathy and the Society of Medical Orthopedic Medicine. These courses encompassed many different forms of manipulation techniques aside from the standard osteopathic and chiropractic techniques, i.e. Strain/Counter-Strain, Muscle Energy (with Dr. Greenman, the creator of Muscle Energy), Joint Play with John Manel its creator, which he learned from his father a bone-setter in the late 1800s in England, Spray-and-Stretch, Cranio-Sacral Therapy, etc.

I took a course in Prolotherapy to heal and tighten ligaments and restore joint stability, (not covered by insurance.)

I studied Mesotherapy, used in France to treat arthritic and musculoskeletal pain, as well cosmetic conditions, in Paris with Doctor La Cos, the cofounder of Mesotherapy. Mesotherapy is covered by insurance in France, but not in the U.S. For over ten years I have been doing Platelet Regenerative Plasma (PRP) injections as well as other growth factor and placenta injections to heal injured joints and muscles.

I was one of the first to use a needle with a camera inside of it to precisely locate the injection site.

I was one of the first doctors to use BOTOX injections into the neuromuscular junction to relieve spasticity in stroke patients, cerebral palsy patients, MS patients, and patients with spinal injuries, years before BOTOX was used cosmetically. None of these injections are covered by insurance. 

I am A Physician not a God Damn Drug Dealer

2.  HOW MY PAIN PRACTICE WAS MULTIMODAL/MULTIDISCIPLINARY

From 1987 until I was arrested in 2020, I maintained a small private practice in Manhattan. As time went on, I put more hours into my private practice. Simultaneously, I conducted clinical trials in my office. Some were for products, most of which were for pain-related.

I participated in approximately 35 clinical trials, most of which were published. I did opioid trials for the major opioid manufacturers.

Eventually I spent half my time in the office treating pain patients and the other half of my time doing clinical trial research. Therefore my knowledge of opioids, their effects and side effects, was extensive. In 1990 I was the doctor for CBS Sports for the Winter Olympics in Alberville.

At the end of 2017, my brother, the owner of Research Across America for which I was doing medical research, sold his company to Synexis. The sale happened suddenly so I suddenly had 20 hours of time on my hands.

I initially increased my hours at Columbus Rehabilitation Center, a CORF (Comprehensive Outpatient Rehab. Facility,) but I also increased my private practice office hours. At the the time I was inundated with patients that either lost their doctor due to retirement, loss of license, incarceration, or death. I took on many of these patients.

My health declined and I stopped working at Columbus. I then started a waiting list for new patients, which grew to over 200 patients long and a year long wait to see me.

If I was concerned about money, I would have hired a nurse practitioner or a P.A. or both. Unfortunately, my increase in hours caused me to write more opioid prescriptions, which put me on the radar of agencies using algorithms which I will describe shortly. The results of this algorithm triggered the investigation of me and helped convict me.

When I started practicing Rehabilitation Medicine and Pain Management, I would see patients by referral. The patient would have a problem and call their primary care physician, then wait two weeks for an appointment. The primary care physician would see them, and send them to a neurologist or an orthopedist or both, which would take another two to four weeks.

These specialists would then refer the patient to me. I then referred them to a physical therapist – this would take another two weeks. The physical therapist would evaluate them and say “Come back in a week for treatment.” By that time the patient was either better, or had developed a severe, chronic problem. This chain of doctor referrals made doctors happy making money. This is the way medicine is currently practiced today.

I decided that this type of system is harmful, expensive, and causes weeks of unnecessary neglected pain. So I decided I would learn every pain management technique so that I could treat the patients when

I saw them, and refer out only the patients that needed referral.

I gave everyone a home exercise program, manipulated them, stretched them, gave physical therapy/massage therapy, (I used to have a massage therapist in my office,) and gave them injections and medications as needed.

I also ordered tests as needed. The legacy patients had many years of treatment and testing prior to seeing me.

They were told there was nothing that could help them except pain medication, which _was_ helping them.Some of my patients had no insurance and couldn’t afford therapy.

The ones with insurance were told that they received the maximum amount of therapy their policy covered. So I treated them myself, each and every visit. My documentation was less than perfect, but Hundreds of my patients would have testified as to how I treated everybody.

3.  THE MOST SHAMEFUL CAMPAIGN IN THIS “WAR ON DRUGS”

When I first heard of doctors selling opioids I didn’t believe it. Then I found out that they pled guilty to a number of charges. I and most people didn’t understand that this is how the justice system can easily be abused. Once it becomes a “drug” investigation, new powers become available.

Federal investigators use wire taps, blackmail, asset seizure, and threats to incarcerate their families to force older doctors to take guilty pleas instead of spending the rest of their lives in prison. If you’re a doctor and you are investigated, you will be charged with _something_) whether you are innocent or not. Some doctors plead guilt to protect their family.

The CDC is responsible for the overdose statistics for the U.S. When the published opioid overdose statistics were made to look as if medical doctors were causing the “opioid epidemic,” two things occurred: 

1. The original OxyContin pills, made by Perdue, made their way to the black market, because they could be crushed, then shot intravenously or snorted. In 2012 Perdue created a “tamper-proof” version of OxyContin which greatly prevented the its abuse because it couldn’t be easily crushed. 

2. Therefore partiers and addicts turned instead to heroin. Pain patients, unable to get pain medications from their doctors, were forced to turn to heroin also, causing the heroin prices to rise. To make heroin cheaper, dealers laced the heroin with carfentanil (an analog of fentanyl, used in illicit drugs, 100 to 1000 times as strong as prescription fentanyl.) This has been going on since 2002.

Addiction specialists, not pain specialists, and the insurance companies went to the Centers of Disease Control (CDC) and pushed the CDC to make guidelines for primary care physicians.

The CDC core group writing these guidelines were mostly addiction specialists, who incorrectly believed that all opioids are evil and all cause addiction in everyone. They had not grasped the difference between _dependence_ and _addiction_. They assumed that whether you have pain or not, if you take opioids, you are addicted. This is patently _false_ – if you take it for pain you are  _dependent_.

Moreover, these CDC guidelines were interpreted by law enforcement as _law_, not guidelines, and doctors were prosecuted.

This has caused the prescriptions for opioids to drop 46%.

This drop caused pain patients to go to the street and buy fake oxycodone which they did not realize contained fentanyl, and they overdosed or died.

A group of opportunistic addiction specialists formed a group called Physicians for Proper Opioid Prescribing (PROP). They spread propaganda about the dangers of opioids. One of the leaders of this group wrote an algorithm to search data using false information, algorithms which targeted doctors.

This data was not scientifically proven nor scrutinized, yet it became a weapon used by law enforcement and prosecutors, (using a computer algorithm similar to the use of psychics in the movie ‘Minority Report’ to predict future crime.)

The PROP doctors made hundreds of millions of dollars testifying against the pharmaceutical companies and as expert witnesses against pain specialists. With the money that was collected from settlements with the pharmaceutical companies, after the lawyers and politicians got their share for their pet projects, nothing was left for the true sufferers of drug addiction.

Only one percent (1%) of pain patients become addicted. The overdoses occur in street partiers, and opioid naive people using opioids prescribed for someone else and using them inappropriately (e.g. crushing it and shooting or snorting it.)

The Veterans Administration (VA) followed the CDC guidelines and tapered off all veterans taking opioids. CDC statistics show that 30% of veterans on opioids committed suicide or overdosed due to this tapering.

Although the New England Journal of Medicine, JAMA, the AMA, and numerous pain societies had warned them that this would happen.

In 2017, the Attorney General of the US, Jeff Sessions, started Operation Pill Mill, with a title crafted to be attractive to the media. The government joined forces with the insurance companies who were using unproven, unscientific algorithms to predict which doctors were going to break the law (see FOIA information.)

The DEA did not have legal access to this information until they were supplied the conclusions of the private algorithms developed by insurance companies, and in my case, CVS Care Mart.

4.  FOIA Information

A research organization assigned a point score to variables unrelated to opioids to determine who to target.

Aside from the amount of opioids the doctors prescribed, points were scored by how many cars they had, the neighborhood they lived in and worked in, if they were in private practice or work in a hospital, how many procedures they performed, how far patients traveled to see them, proximity to pharmacies, their race, sex, ages, religion, where they went to medical school (especially foreign countries,) how often they prescribed brand medically necessary medication and anti-viral drugs (which are more expensive for the insurance company) and other arbitrary factors, to determine a composite score.

They then gave this information to the DEA with instructions to target the doctors with scores over a threshold of 80 points, and that if this didn’t target enough doctors, to drop the threshold to 70 points.

There is still a lot of FOIA information that was not released, however, CVS Caremark was part of this Operation Pill Mill and had its own algorithm based on racism, ageism, antisemitism, and junk science.

The data that has been disclosed so far indicates that 80% of the doctors who were arrested lost their licenses or were forced to take a plea were over 60 years of age. It was easier to threaten these doctors and their families and force the doctors to plead guilt. Again, it is highly irregular for such a large number of medical professionals to suddenly decide to become drug dealers at age 60.

However, these individuals had assets, IRAs, and 401Ks that were easy to seize. Of this group, the numbers paint a grim picture. One does not need ta degree in statistics to see what was going on here in terms of targeting.

5.  THIS HAS HAPPENED BEFORE

In the late 1800s, Dr. Ignaz Semmelweis was an obstetrician in Geneva Switzerland. During an epidemic of women dying of a strange infection after giving birth, Semmelweis figured out it was due to bacteria being spread from one delivery to the next.

Doctors at the time kept the blood on their gowns as a “red badge of honor,” showing how many deliveries they did by how dirty their uniforms were.

Semmelweis urged doctors to wash their hands and wear clean gowns, but his colleagues laughed at him and kicked him out of medical societies and hospitals, and continued to spread the postpartum infection.

Part of his ostracization was because he was Jewish. He became depressed and ultimately committed suicide. It took 15 years after his death for the doctors in Europe to adapt his recommendations of handwashing.

In the early 1900s, due to prejudice against Chinese immigrants, the Harrison Act was passed into law. The initial target was Chinese opium dens, but “mission creep” made this spread to doctors treating pain and many medical conditions, resulting in thousands of doctors thrown into prison.

Oliver Wendell Holmes Senior, father of the Supreme Court Justice of the same name, is famous for putting an end to these postpartum infections that were killing many women who gave birth in U.S. hospitals. He made doctors wash their hands between deliveries.

He ended the epidemic and was made the first Dean of Harvard Medical School. He then founded the field of anesthesiology, which at the time was mostly the administration of morphine, the precursor of modern opioids.

At the first meeting of the Boston Medical Society, he gave a speech railing against the Harrison Act which limited doctors in  their ability to use morphine.

In his speech he said in words to the effect,

“If you throw all the medicine in the world into the ocean, it would be the worst day for the fishes and the best day for humankind…_except_ for the POPPY, the mother of morphine, the plant which God made so beautiful for a reason. Without the poppy, medical treatment could not exist – no surgery could be performed, pain and suffering would go unchecked, and we could not survive.”

Today’s attack on opioids is the same as it was back then, just with different names.

In 1972, Candice Perth discovered the opioid receptor, which is present in every organ of the human body, not just the brain. Why do we have opioid receptors if not for opioids.

The body even produces its own “morphine” called endorphins, some of which are 100 times stronger than morphine. They are produced during exercise, sex, and so on. Are we going to outlaw these activities because they are addictive also?

Addiction _does_ occur in one percent (1%) of the population due to genetics. The rest is caused by psychosocial issues, not due to the chemical action of drugs. Addiction to driving fast, jumping out of planes, sex, video games, sugar, coffee, cigarettes, etc. are comparable to opioids. (See the ‘Rat Park’ TED talk.) 

When I started practicing in the mid-1980s, Percoset came in only 5 mg oxycodone with 325 mg of Tylenol. When I heard of people overdosing on Percocet, it was always from the Tylenol, not the oxycodone. Subsequently, Percocet was produced with 10mg oxycodone and 325 mg Tylenol, which made it theoretically safer than giving a person two 5mg tabs.

Since oxycodone’s potential to cause addiction is not dose-related, that allowed the FDA to avoid putting a maximum dose on the prescribing of oxycodone. This led to the creation of OXYCOTIN, high dose oxycodone in the pure form, in time-release pills. 

The number of deaths due to NSAIDs far exceeds the deaths due to opioids.

6.  MY CASE IS TYPICAL

I had not done anything wrong over a career in pain management spanning decades, long preceding the “opioid epidemic.” I believed I could stand up to any scrutiny. If ever investigated, I believed the justice system would reveal this truth.

But Federal agents started their investigation in 2017, just when the PMP (Physician Monitoring Program) became mandatory in New York.

They raided my office in 2018, and took my computers, my research phones, my iPad, all my patient files, all the records of the patients that paid and the patients that owed me fees, which is what I was going to use to prepare tax returns.

My attorney asked for these documents back numerous times and was told each time “you’ll get these back in a month,” but I never got anything back. Taking all this information greatly hampered my practice – I didn’t even have phone numbers to call my patients or an appointment book.

They said I could get my computer back if I paid $25,000 for a forensic examination “to prove you’re not going to change the data.” 

But I refused to plead guilty to something I didn’t do!!

Judge Wood of the Second Circuit was initially my trial judge. She had my motions to dismiss for six months, and didn’t act on them until three days before my trial, writing “Denied” on them without any explanation, then recused herself. Judge Rakoff assumed the bench. 

Using witnesses from among my thousands of my patients, the government prosecutors selected the very few with legal problems they could exploit, then offered them promises of immunity if they testified against me.

Then they coached these selected witnesses before they took the stand.

The prosecution’s expert witness testified without knowing or acknowledging that he didn’t have my notes on patients for the last two years I practiced because these notes were not given to him.

My X-ray reports and films for four years were also not made available to him. Yet he testified that I had “no reason to raise doses.” Either he did not know of the existence of the notes, X-ray reports and films or he gave his opinion regardless of them.

The CDC guidelines were created as a reaction to their false data which included reports which mixed street fentanyl and methadone stolen from clinics together with prescription drug use  in their overdose statistics from 2002-2018 in the column “Doctor-prescribed opioids,” making it look like doctors prescribed these illicit drugs.

They did not correct these data before 2020, a month before my trial, even though mandated to do so by Congress back in 2018.

The prosecution asked their expert witness “What are the CDC guidelines based on”, _knowing_ they were based on faulty data, because my attorney _gave_ them the corrected data as evidence. The judge would not allow this to be entered. The expert answered “By the morbidity and mortality in the community,” when in reality, the guidelines were based on street fentanyl. 

Three prosecutors asked four witnesses who had been my patients about their last doses of opioids: “When was the last time you took opioids?”

All testified “The last time I was in the office.” These witnesses were next asked “What did you do about  your addiction?” All witnesses answered with the same words, “I went into a program.” All witnesses were next asked “What did you do for your pain after you stopped taking opioids?”

They all answered that they took Tylenol, Motrin, or ALEVE.

If the patient-witnesses went into a program, most programs are very long. It seemed as if they were referring to a short program, which meant they were _dependent_, not _addicted_. [All people on opioids more than two weeks are dependent, therefore the witnesses were lying about their addiction.]

Click here for the video (takes a few seconds to load) to see the Daily Remedy Podcast by Jay Joshi, M.D., with guest star L. Joseph Parker, M.D. discussing Dr. Sasaki as the perfect example of DEA/DOJ exploiting & prosecuting doctors for doing the right thing.

If they were in a typically long program, they were in a MAT program (Medication Assisted Treatment.) These medications consisted of methadone or Suboxone (Buprenorphine/naltrexone.)

These are both opioids, both of which have higher Morphine Milli-Equivalents than oxycodone. Both of these medications are used for pain. Therefore, when the patient-witnesses said they were not taking opioids, they were lying. If they were taking Tylenol, Motrin, or ALEVE, their pain was real, and required medication above the MME of methadone or Suboxone, both potent medications used to treat pain.

In the famous Triangle Shirt Factory Fire criminal case, defendants were acquitted based on identically-worded testimony given by multiple witnesses, proving their testimony was choreographed by the prosecution.

The prosecution’s expert witness said words to the effect “It’s clear to me that Dr. Adelglass was trying to addict young patients to force them to come back for follow-up visits to create an income stream.” Expert witnesses are not allowed to speak on mens rea (guilty mindset), yet he did so. The judge admonished him once after he spoke over an objection, but the expert witness still got his opinion into testimony.

The prosecution’s expert testified “Young people have greater tendency to become addicted.” This is _not_ supported by any literature. The medical literature supports the assertion that people of _all_ ages have the same propensity to addiction except if they have the opioid addiction gene. Age is irrelevant, except that young people tend to experiment earlier with illicit drugs.

My attorney asked my medical expert “What percentage of people fake pain to get meds?” The judge said “You can’t ask that because none of the witnesses said they were faking.” Yet three of the witnesses said the were lying to me in every visit to get pain meds. What is the difference between faking and lying?

The prosecution’s expert witness testified “A higher dose of opioid is more likely to get someone addicted.” This is not supported in the medical literature. People get just as easily addicted from 5 mg of oxycodone as from 30 mg of oxycodone.

The prosecution’s expert witness testified “The skin fentanyl patch is only used for end-of-life or cancer patients.” In reality, the buccal (gum) or sublingual (under the tongue) forms are for end-of-life, not the skin patch.

The prosecution’s expert witness testified that my pain psychologist was faking his notes. That psychologist was using the same notes in paper form that the expert witness was using the form of computer notes.

The psychologist was intimidated by the Government, because he worked in the same department as and was supervised by the prosecution’s expert witness. Yet that psychologist suffered no ramifications for his cover-up. Instead he was rewarded by keeping his job.

The prosecution’s expert witness said “Dr. Adelglass’s prescriptions would have been acceptable in a multimodal setting.” My practice _was_ multimodal. 

The prosecution’s expert witness testified “Dr. Adelglass’s biggest problem was that he went too far over the CDC’s MME guidelines. But these guidelines were developed in 2016 and were _guidelines_, not law.

Regardless, the CDC saw the catastrophic results of these guidelines and two days before the end of the trial, the CDC eliminated the use of MME for maximum dosing.

Yet neither the judge nor the jury heard this. And _everyone_, (the AMA, the NEJM, all the pain societies, and my expert witness) knew the CDC would have to eliminate the MME and modify the guidelines.

My Defense attorney asked the prosecutor’s expert witness about “fentalogues.” The expert witness responded “I don’t know what you’re talking about.” “fentalogues” is a common term in practice, a contraction of “fentanyl” and “analogue,” just as many other medicines have analogues, chemically and functionally similar compounds. Fentanyl analogues have been in the newspapers so long, the common man would understand the term.

An analogy to the expert’s response would be if he understood the words “can” and “not,” but did not understand the contraction “can’t.”

A DEA agent who testified against me said that she saw a person drooling in my waiting room. Yet she didn’t take the person’s name, she didn’t notify me, they renewed my DEA license and my waiver for two years, the FBI interviews did not mention this incident, but they did mention that two people were in my office that weren’t my patients. Opioids cause dry mouth, not drooling.

I reported stolen prescriptions to the DEA sixteen times, which is in my discovery, and the DEA agent was supposed to be interviewed about that. But her answer was “That was another agent. I don’t know anything about it.”

A second DEA agent, in charge of diversion in Washington D.C. did not know the difference between addition, dependence, and tolerance. She knew nothing about the statistics of opioid overdoses going up since the CDC guidelines came out, and nothing about the fact that doctors were prescribing 46% less opioids.

The judge wanted a speedy trial and did not allow witnesses in my defense. I was tried as a drug dealer and not as a physician.

7.  RESULTS – NEEDLESSLY SUFFERING AND DYING PATIENTS

In my practice, one patient, an attractive young woman with three young children, presented with chronic back pain for over five years. She had been receiving high dose opioids from her physician who was forced out of practice. I checked the PMP and it showed she hadn’t received opioids from a doctor for over three months. i told her I could not give her the prescription she as given in the past. She told me she was buying the same dose she was receiving from her prior doctor on the street, and couldn’t afford it any more.

I told her that the most I could give her was 10 mg Percoset, five a day, #35. This was one third of what she was taking from her prior physician. She begged me to give her a higher dose. I refused, and said “Come back in a week. Bring your films, and I will possible do some treatments on you, i.e. manipulations, injections, etc. And if it didn’t work I would raise the dose.” I assured her I would not charger her my regular fee until she was at a comfortable level of pain.

She returned home, where her husband said “You’re too pretty. That’s why the doctor didn’t believe you.” She went into their garage and hung herself.

In my practice alone, no patients died while I was practicing. I asked the FBI “What will happen to all my patients?” Their response was “Don’t worry, your drug addicts will do just fine.”

After I stopped practicing, seven of my patients died, as they were unable to find doctors to prescribe them opioids, and they either went into withdrawal and died from their underlying medical conditions, or died from tainted oxycodone bought on the street, or committed suicide.

Recently, one patient called her sister and said she couldn’t live any longer without my injections and medications, and jumped in front of a subway train.

8.  RESULTS – IMPRISONED DOCTORS AND MORE

Since I’ve been in prison since November 2022 I’ve encountered many doctors that treated pain, i.e. pain doctors, physiatrists, anesthesiologists, ER doctors, a podiatrist, etc., doctors who prescribed opioids as a part of their practice. Almost all of these doctors were over 60 years of age, foreign medical school graduates and all were Asian, Black, Hispanic, and Jewish.

There were approximately 6000 pain doctors practicing in the United States four years ago, now there are fewer than 4000. Fellowships have been left vacant for the first time in 30 years. Doctors are retiring and leaving medicine in droves, due to the Government’s crackdown on their practices.

Doctors have cut down opioid prescriptions and overdoses have risen by 167%.

I filed for a FOIA, and unfortunately, since I was unable to obtain legal assistance, my FOIA was denied. however, a group of doctors in my same situation received information that shows that the insurance companies were using algorithms that were unscientific, racist, ageist, and money-based to target doctors that were easier to eliminate and save them money.

9.  RUAN V. UNITED STATES – SCOTUS DECISION

The Supreme Court opinion in Ruan v. United States addresses the mens rea, or mental state, required for a medical doctor to be convicted under 21 U.S.C. § 841 for unlawfully dispensing controlled substances.

The Court held that the statute’s “knowingly or intentionally” standard applies to the “except as authorized” clause, meaning the government must prove a doctor knew or intended to prescribe outside legitimate medical purposes and professional practice after the defense presents evidence of authorization.

Justice Alito’s concurrence agrees with the judgment to vacate and remand the lower court decisions but argues that the majority incorrectly frames the authorization as something akin to an element of the offense rather than an affirmative defense, and disputes the assignment of the burden of proof.

Ruan was a physiatrist/pain management specialist who had six Board certifications.

He lost his court case and his appeals, but the Supreme Court, in a unanimous 9-0 decision, decided that a physician had to prescribe opioids that they knew were illegal for a conviction. Yet Ruan is still in prison. He was tried as a criminal, not as a physician. 

This decision has helped many physicians who were incarcerated and went to court after Ruan.

Dr. Sanjay Kumar, who is here with me at Butner, just had his conviction dismissed, after being behind bars for over three years. Dr. Smithers and other North Carolina doctors had their convictions overturned due to Ruan and the improper use of “willful blindness.” I’m in the Second Circuit, which believes in “willful blindness.”

In my case, the Second Circuit Court used a conspiracy charge and “willful blindness” (the accusation that I was “hiding my head in the sand” when my patients lied to me)to skirt around my mens rea (guilty mindset.) But I was a physician, not a police officer.

It’s one thing to do urine tests in the office, and ask people who’ve thus shown inappropriate behaviors to leave. But I don’t have E.S.P. and it’s not taught in medical schools. There have been studies that show, when compared to FBI agents, doctors’ ability to pick out liars was no different than the FBI agents.’

Just appealing to the Ruan decision is not enough to clear a convicted doctor.

10. CONCLUSION

The current opioid epidemic is clearly being caused by law enforcement arresting doctors, forcing their patients to go to the street to get medications for their pain tainted with fentanyl and dying. 

Doctors did not go through medical school, residency, and fellowships, to decide at the age of 60 to become drug dealers. Most of these doctors are minorities or foreigners. When faced with imprisonment of their family, loss of all their assets, and long prison terms equivalent to death sentences, they take a guilty plea. When they are robbed of their assets through asset forfeiture, they can no longer afford an attorney who can adequately defend them. I had a pubic defender.

The government uses all the resources of the government against doctors.

I am currently in the midst of my appeal. I am hoping for the best. I’m not sure what you can do for me, but you can certainly help the situation that’s happening to doctors and patients across the country.

When I started, if you didn’t give high dose opioids, you were considered masochistic. now you’re considered “an addict or” and  a “murderer.” Who knows what tomorrow will bring.

WE ARE PHARMACISTS, PHYSICIANS, DENTISTS NURSE PRACTITIONERS not God Damn Drug DealerS

Thank you for your time,

To get in touch with me:

Through my daughter Finise Avery Adelglass: Finisea@gmail.com

My attorney: Debra Colson,  dcolson@colsonlaw.com, (917) 543-6490.

My current address is Howard Adelglass #18069509, Wake-A, Box 999, Butner, North Carolina 27509.

An additional contact is James Wyman: jim.wyman@mindspring.com,

FOR NOW, YOU ARE

WITHIN

THE NORMS

REFERENCES:

Briefing Document: DR. HOWARD ADELGLASS, MD., “A Doctor in Prison: The Opioid Prosecution Crisis”

Date: October 26, 2023 Source: Excerpts from a letter written by Dr. Howard Adelglass, a former physician incarcerated in Federal Correctional Institution at Butner, North Carolina, to the President of the American Medical Association (AMA).

Executive Summary

This briefing document summarizes the core arguments and factual claims presented in Dr. Howard Adelglass’s letter detailing his experience and perspective on the “opioid prosecution crisis.” Dr. Adelglass, a 69-year-old former pain management specialist with an extensive and multidisciplinary background, argues that the aggressive prosecution of physicians for opioid prescribing is a “shameful campaign” based on “junk science,” biased experts, and flawed algorithms.

He contends that this crackdown has led to the needless suffering and death of patients, the unjust imprisonment of numerous well-meaning doctors (disproportionately older and from minority groups), and an increase in the illicit drug trade as patients are denied legitimate pain relief.

Dr. Adelglass believes his case is typical of this trend and highlights the detrimental impact of the CDC guidelines (initially misinterpreted and later revised), the exploitation of vulnerable patients by prosecutors, and the limitations of the justice system in understanding complex medical practices. He calls upon the AMA to recognize and address this “misguided and malicious treatment of doctors.”

Main Themes and Important Ideas/Facts:

1. Unjust Prosecution of Physicians: Dr. Adelglass argues that many doctors, including himself, are being unfairly targeted and prosecuted under the guise of combating the opioid crisis, despite acting in their patients’ best interests. He states, “In speaking to many doctors in a similar position to mine it became clear that very few of them were guilty. They were being forced to take guilty pleas…” This coercion, he claims, is due to threats of lengthy prison sentences, asset forfeiture, and the immense cost of legal defense. He asserts that prosecutors exploit the system, securing convictions even when guilt is questionable.
2. Flawed Science and Misinterpretation of Data: The letter strongly criticizes the scientific basis and interpretation of data used to drive the anti-opioid campaign. Dr. Adelglass points out that the CDC guidelines, initially intended for primary care physicians, were misinterpreted as law and based on flawed overdose statistics that conflated illicit drugs with prescribed opioids. He quotes, “These CDC guidelines were interpreted by law enforcement as law, not guidelines, and doctors were prosecuted.” He also highlights the role of “junk science” and “unproven and untested algorithms” used to target physicians.
3. Harm to Patients: A central theme is the devastating impact of these prosecutions on patients with chronic pain. Dr. Adelglass argues that restricting access to opioid medications has forced patients to seek relief through the illicit drug market, leading to overdoses from fentanyl-laced drugs and increased heroin use. He shares tragic anecdotes, including the suicide of a patient who couldn’t obtain adequate pain relief after he was forced to reduce her medication. He states, “Thousands of patients are losing competent care, then suffering, even dying by their own hands, and traffic in illicit drugs has increased as a result of this anti-opioid campaign.”
4. Targeting of Specific Doctor Demographics: Dr. Adelglass alleges that the prosecutions disproportionately affect older doctors and those from minority or foreign medical school backgrounds. He claims these individuals are easier to threaten and coerce into guilty pleas, especially given the potential for asset seizure. He cites FOIA information suggesting that algorithms used to identify targets included factors like age, race, and origin of medical education. He notes, “The data that has been disclosed so far indicates that 80% of the doctors who were arrested lost their licenses or were forced to take a plea were over 60 years of age.”
5. Critique of Expert Witnesses and Prosecution Tactics: The letter details several issues with the prosecution’s case against Dr. Adelglass, including the selective use and coaching of patient witnesses with legal troubles, the testimony of an expert witness who lacked complete information and offered opinions on his “mens rea” (guilty mindset), and the misrepresentation of CDC guidelines. He highlights inconsistencies in witness testimony and the exclusion of exculpatory evidence.
6. Historical Parallels: Dr. Adelglass draws parallels between the current situation and historical instances of medical persecution based on prejudice and misinformation, such as the treatment of Dr. Ignaz Semmelweis and the impact of the Harrison Act. He quotes Oliver Wendell Holmes Sr. to emphasize the essential role of the poppy (source of morphine) in medicine. He argues, “Today’s attack on opioids is the same as it was back then, just with different names.”
7. The Ruan v. United States Supreme Court Decision: Dr. Adelglass acknowledges the Supreme Court’s unanimous decision in Ruan v. United States, which stated that a physician must have knowingly prescribed opioids illegally for a conviction. However, he points out that Dr. Ruan remains incarcerated and that the Second Circuit (where his case was tried) uses “willful blindness” arguments to circumvent the mens rea requirement. He laments, “He was tried as a criminal, not as a physician.”
8. Impact on the Medical Profession: Dr. Adelglass describes the chilling effect of these prosecutions on the medical profession, leading to a decrease in pain management specialists, vacant fellowship positions, and doctors retiring early. He states, “Doctors have cut down opioid prescriptions and overdoses have risen by 167%.” This underscores his argument that the crackdown is counterproductive.
9. Multimodal Practice and Good Intentions: Dr. Adelglass emphasizes that his pain management practice was multimodal and that he genuinely tried to help his patients. He details his extensive training in various pain management techniques and his efforts to provide comprehensive care. He states, “I was not guilty of anything but trying to help my patients…”

Key Quotes:

• “More licensed and experienced doctors will soon be thrown into prison as thousands of them have been already, and their families impoverished because they are targets of malicious prosecution using junk science.”
• “We share a common belief about the misguided and malicious treatment of doctors over the past few years based on fake science, biased experts, and unproven and untested algorithms used to target innocent well-meaning physicians, ruining their lives and their families’ and their patients’ lives.”
• “They were being forced to take guilty pleas as they were over 60 years of age, were Black, Asian, Hispanic, Jewish, or were foreign medical school graduates. They were threatened with over 20 years in prison, loss of all their assets, and arrest of their family.”
• “The CDC is responsible for the overdose statistics for the U.S. When the published opioid overdose statistics were made to look as if medical doctors were causing the ‘opioid epidemic,’ two things occurred…”
• “These CDC guidelines were interpreted by law enforcement as law, not guidelines, and doctors were prosecuted.”
• “Only one percent (1%) of pain patients become addicted. The overdoses occur in street partiers, and opioid naive people using opioids prescribed for someone else and using them inappropriately…”
• “The government joined forces with the insurance companies who were using unproven, unscientific algorithms to predict which doctors were going to break the law…”
• “The data that has been disclosed so far indicates that 80% of the doctors who were arrested lost their licenses or were forced to take a plea were over 60 years of age.”
• “Today’s attack on opioids is the same as it was back then, just with different names.”
• “If you throw all the medicine in the world into the ocean, it would be the worst day for the fishes and the best day for humankind…except for the POPPY, the mother of morphine, the plant which God made so beautiful for a reason. Without the poppy, medical treatment could not exist – no surgery could be performed, pain and

Timeline of Main Events

• 1914: The Harrison Narcotics Act is enacted. This act is a predecessor to the Controlled Substances Act and is interpreted by the Supreme Court to include an exception for prescriptions issued by registered physicians “in good faith” and “in the course of his professional practice.”
• 1970: The Controlled Substances Act (CSA), codified at 21 U.S.C. §841, is enacted. It makes it a federal crime to knowingly or intentionally manufacture, distribute, or dispense a controlled substance, “[e]xcept as authorized.”
• Prior to Trials: Xiulu Ruan and Shakeel Kahn are licensed medical doctors authorized to prescribe controlled substances.
• Prior to Trials: Ruan and Kahn are separately charged by the government with unlawfully dispensing and distributing drugs in violation of 21 U.S.C. §841. The government argues their prescriptions were not for a legitimate medical purpose or outside the usual course of professional medical practice.
• Ruan’s Trial:Ruan argues his drug dispensation was lawful due to valid prescriptions.
• Ruan requests a jury instruction requiring the government to prove he subjectively knew his prescriptions were outside his prescribing authority.
• The District Court rejects Ruan’s requested instruction and instead provides a more objective standard, instructing the jury that a doctor acts lawfully when prescribing “in good faith as part of his medical treatment of a patient in accordance with the standard of medical practice generally recognized and accepted in the United States.” The court also instructs that a violation occurs if the doctor’s actions were not for a legitimate medical purpose or outside the usual course of professional practice.
• The jury convicts Ruan.
• Ruan is sentenced to over 20 years in prison and ordered to pay millions in restitution and forfeiture.
• Kahn’s Trial:Kahn similarly argues his drug dispensation was lawful.
• The District Court instructs the jury not to convict if they found Kahn acted in “good faith,” defined as “an attempt to act in accordance with what a reasonable physician should believe to be proper medical practice” and an “honest effort to prescribe for patients’ medical conditions in accordance with generally recognized and accepted standards of practice.” The court also states “good faith” is a “complete defense.”
• The jury convicts Kahn.
• Kahn is sentenced to 25 years in prison.
• Appeals to the Eleventh Circuit (Ruan): The Eleventh Circuit affirms Ruan’s conviction, holding that a doctor’s subjective belief in meeting a patient’s medical needs is not a complete defense and that whether a defendant acts in the usual course of professional practice must be evaluated based on an objective standard.
• Appeals to the Tenth Circuit (Kahn): The Tenth Circuit affirms Kahn’s conviction, holding that the government must prove the doctor either subjectively knew a prescription was not for a legitimate medical purpose or issued a prescription objectively not in the usual course of professional practice.
• Certiorari to the Supreme Court: Both Ruan and Kahn file petitions for certiorari to the Supreme Court. The Supreme Court grants the petitions and consolidates the cases.
• March 1, 2022: The Supreme Court hears oral arguments in the consolidated cases of Xiulu Ruan v. United States and Shakeel Kahn v. United States.
• June 27, 2022: The Supreme Court issues its decision. The Court holds that the “knowingly or intentionally” mens rea in 21 U.S.C. §841 applies to the “except as authorized” clause. This means that once a defendant produces evidence their conduct was authorized, the government must prove beyond a reasonable doubt that the defendant knew they were acting in an unauthorized manner or intended to do so. The Court vacates the judgments of the Courts of Appeals and remands the cases for further proceedings consistent with its opinion, leaving it to the lower courts to determine if the jury instructions complied with the new standard and whether any error was harmless.

Cast of Characters

• Xiulu Ruan: A medical doctor licensed to prescribe controlled substances. He was convicted under 21 U.S.C. §841 for prescribing in an unauthorized manner, a conviction affirmed by the Eleventh Circuit but later vacated and remanded by the Supreme Court.
• Shakeel Kahn: A medical doctor licensed to prescribe controlled substances. He was also convicted under 21 U.S.C. §841 for prescribing in an unauthorized manner, a conviction affirmed by the Tenth Circuit but later vacated and remanded by the Supreme Court.
• United States: The prosecution in both cases, representing the federal government in its enforcement of 21 U.S.C. §841.
• District Court (Ruan’s Trial): The trial court that presided over Xiulu Ruan’s criminal trial, rejected his requested jury instruction on subjective knowledge, provided an objective standard instruction, and ultimately convicted him.
• District Court (Kahn’s Trial): The trial court that presided over Shakeel Kahn’s criminal trial, instructed the jury on a “good faith” defense based on a reasonable physician standard, and ultimately convicted him.
• Eleventh Circuit Court of Appeals: The appellate court that affirmed Xiulu Ruan’s conviction, emphasizing an objective standard for evaluating whether a doctor acted in the usual course of professional practice.
• Tenth Circuit Court of Appeals: The appellate court that affirmed Shakeel Kahn’s conviction, holding that the government needed to prove either subjective knowledge of a lack of legitimate medical purpose or an objectively unauthorized prescription.
• Supreme Court of the United States: The highest court in the federal judiciary, which reviewed the decisions of the Eleventh and Tenth Circuits, ultimately holding that the “knowingly or intentionally” mens rea of §841 applies to the “except as authorized” clause and remanding the cases.
• Justice Breyer: The Justice who delivered the opinion of the Supreme Court in Ruan v. United States and Kahn v. United States.
• Chief Justice Roberts: Joined Justice Breyer’s opinion.
• Justice Sotomayor: Joined Justice Breyer’s opinion.
• Justice Kagan: Joined Justice Breyer’s opinion.
• Justice Gorsuch: Joined Justice Breyer’s opinion.
• Justice Kavanaugh: Joined Justice Breyer’s opinion.
• Justice Alito: Filed an opinion concurring in the judgment, joined by Justice Thomas and partially by Justice Barrett. Justice Alito disagreed with the Court’s reasoning, arguing that the “except as authorized” clause creates an affirmative defense and that the Court’s new hybrid approach is unnecessary and potentially confusing. He also argued for a “good faith” defense based on precedent from the Harrison Narcotics Act.
• Justice Thomas: Joined Justice Alito’s concurring opinion.
• Justice Barrett: Joined Parts I-A, I-B, and II of Justice Alito’s concurring opinion.
• Linder v. United States: A 1925 Supreme Court case interpreting the Harrison Narcotics Act, holding that a registered physician acts “in the course of his professional practice” when prescribing “in good faith.” This precedent was discussed in Justice Alito’s concurring opinion.
• United States v. Moore: A 1975 Supreme Court case discussing the limitations on a physician’s authorization to dispense controlled substances under the CSA, stating it is limited to “the dispensing and use of drugs ‘in the course of professional practice or research.'” This case was referenced by both the majority and the concurrence.
• Gonzales v. Oregon: A Supreme Court case that described the regulatory language defining an authorized prescription under the CSA as “ambiguous” and “open to varying constructions.”
• Rehaif v. United States: A 2019 Supreme Court case that established that the government must prove a defendant charged with possession of a firearm by a prohibited person knew of their prohibited status. This case heavily influenced the Court’s reasoning regarding the presumption of scienter.
• Liparota v. United States: A Supreme Court case interpreting the mens rea requirement for a statute concerning the unauthorized use of food stamps, holding that “knowingly” applied to the authorization element. This was a key precedent cited by the Court.
• United States v. X-Citement Video, Inc.: A Supreme Court case interpreting the mens rea requirement for a statute concerning the knowing transportation of child pornography, holding that “knowingly” applied to the element of the minor’s involvement. This was another important precedent cited by the Court.
• 21 CFR §1306.04(a): The federal regulation defining an “effective” prescription as one “issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.” This regulation was central to the legal questions in the cases. This regulation was central to the legal questions in the cases.
• 21 U.S.C. §885: A provision of the CSA stating that the government does not need to “negative any exemption or exception” in pleadings or at trial, and that the burden of going forward with evidence for such exceptions lies with the defendant. This provision was a key point of contention regarding whether lack of authorization is an element of the offense.

Conclusion:

Dr. Adelglass’s letter presents a powerful and concerning narrative of the opioid prosecution crisis from the perspective of an incarcerated physician.

He argues that the current approach is unjust, based on flawed premises, and ultimately harmful to patients. His detailed account, supported by specific examples and allegations of systemic issues, warrants careful consideration by the AMA and other relevant stakeholders.

The letter serves as a plea for recognition of the unintended consequences of the aggressive crackdown on opioid prescribing and calls for a more balanced and evidence-based approach to addressing the opioid crisis that prioritizes patient care and due process for physicians.