CLAUDIA MERANDI: THE KINGS’ COURT, “WHERE EVERY MAN IS A KING WHEN THEY HAVE SOMEONE TO LOOK DOWN UPON,” THE RETURN TO THE PRIMITIVE AND THE PAIN OF DENIAL.. “It is So Hereby Ordered”

“Two things are infinite: the universe and human stupidity; and I’m not sure about the universe.”

Albert Einstein

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KINGS THRONE

“…however we are sure about dr. timothy e. king, md (t.e.k.) of the Lost League of Pain Care Medicine

norman j clement, kph, dds

from 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., 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., M.B.A., 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

Book cover of 'It Can't Happen Here' by Sinclair Lewis featuring bold red and black typography.

The Theme of this Article is a depiction centered around Sinclair Lewis’ 1935 Fictional Novel

“It Can’t Happen Here”

..and the work of Doctor Patient Forum led by Claudia Merandi

A woman speaks on video conveying criticism of Dr. Timothy E. King, discussing his actions against physicians who treat pain and addiction, with his profile pictured in the background.
CLAUDIA MERANDI

THE KINGS’ COURT AND THE RETURN TO THE PRIMITIVE

Claudia Merandi: On The King’s Court “Debunking His Opioid Myths and Weaponizing Policies”.

Doctrine of Victory from the Lost League of Pain Care Medicine

“…In that costume, he looked like a sawed-off museum model of a medicine-show “doctor,” and indeed it was rumored that he had played the banjo and done card tricks and handed down medicine bottles and managed the shell game for no less scientific an expedition than Old Dr. Alagash’s Traveling Laboratory, which specialized in the Choctaw Cancer Cure, the Chinook Consumption Soother, and the Oriental Remedy for Piles and Rheumatism Prepared from a World-old Secret Formula by the Gipsy Princess, Queen Peshawara.

A whimsical character dressed in Victorian-style clothing, wearing a bowler hat, large glasses, and a mustache, standing in front of colorful carnival signage.
The Amazing Dr. T. E. King, MD (T.E.K.) of the Lost League of Pain Care Medicine

The Government Men of Legal Mines and Statue aka the Company, ardently assisted by T.E.K. of the Lost League of Pain Care Medicine, killed off quite a number of persons who, but for their confidence in Dr. Alagash’s bottles of water, coloring matter, tobacco juice, and raw corn whisky, might have gone early enough to doctors.

@bobsheerin.apdf

#stitch with @dkhorv @shirlb3215 @snarkilyandrew60 @amtopmpain @apdf2020 @nurse_nya #chronicpain #pain

♬ original sound – Bob Sheerin
Bob Sheerin: Pain Care Advocate

But since then, T.E.K. had redeemed himself, no doubt, by ascending from the vulgar fraud of selling bogus medicine, standing in front of a megaphone, to the dignity of selling bogus economics, standing on an indoor platform under mercury-vapor lights in front of a microphone……during one of his orgasms of oratory, but he had been told by political reporters that under the spell you thought King was Plato, but that on the way home you could not remember anything he had said.

King of the Lost League of Pain Care Medicine assertions that prescriptions of opioids should be deemed illegitimate if there is no objective evidence of functional improvement among patients.

This premise, however, fails to account for the inherently subjective nature of pain – a critical factor in assessing the effectiveness of pain management.

There were two things, that distinguished this Hoosier Demosthenes of Mystical Medical Science. He was an actor of genius.

There was no more overwhelming actor on the stage, in the motion pictures, nor even in the pulpit.

Infographic on predictive modeling showing various data visualizations including graphs, charts, and statistics related to demographic trends and counterfactual analysis.

He would whirl arms, bang tables, glare from mad eyes, vomit Biblical wrath from a gaping mouth; but he would also coo like a nursing mother, beseech like an aching lover, and in between tricks would coldly and almost contemptuously jab his crowds with figures and facts— figures and facts that were inescapable even when, as often happened, they were entirely incorrect.

A man dressed in a vintage carnival outfit holds a banjo in one hand and playing cards in the other, standing under colorful decorative tents with dim lighting in the background.
The Lost League of Pain Care Medicine’s Dr. Timothy E. King, MD or T.E.K.’s Traveling Show of Court Room Deception

But below this surface stagecraft was his uncommon natural ability to be authentically excited by and with his audience, and they by and with him… there is but history before and behind us that betolds our …it can’t possibly happen here…again…”

An animated emoji character with a bald head and a confident expression, making a punching gesture.

From thee…Book of Russo:

“...Then imagine having to listen to a bunch of Assistant U.S. Attorneys and FBI Special Agents hilariously try and somehow explain the “Standard and Scope of Practice” of the sub-specialities of anesthesiology, addictionology and interventional pain in a criminal case where they are actively employing every type of legal BS mumbo-jumbo  possible to throw you in prison for 20 years. There were dozens of moments where we did everything in our power to keep from falling out of our chairs and rolling around on the floor laughing. It was that bad and you just can’t make this shit up...”

Doctor holding an orange prescription bottle with white tablets, demonstrating a clinical overview of opioid dispensing metrics.
A man in a formal black suit with a red tie stands outdoors, in front of leafless trees.
DR. TIMOTHY E. KING, MD “Timothy King, (T.E.K.) of the Lost League of Pain Care Medicine, commonly referred to as the “RAT KING,” stands as a testament to the depths to which certain individuals will sink to satisfy their personal agendas.”

FROM FICTION TO FACTS THE BOOK OF REVELATION 1936 SINCLAIR LEWIS “IT CAN’T HAPPEN HERE”

@cmerandi1

#greenscreen The Doctor Patient Forum is traveling throughout the US meeting with lawmakers/state medical boards to discuss the undertreatment of pain Please consider Donating at the DPF, a 501c3 #thedoctorpatientforum

♬ original sound – Claudia A. Merandi

“(4) Believing that only under God Almighty, to Whom we render all homage, do we Americans hold our vast Power, we shall guarantee to all persons absolute freedom of religious worship, provided, however, that no atheist, agnostic, believer in Black Magic nor any Jew who shall refuse to swear allegiance to the New Testament, nor any person of any faith who refuses to take the Pledge to the Flag, shall be permitted to hold any public office or to practice as a teacher, professor, lawyer, judge, or as a physician, except in the category of Obstetrics. (pg.62-63)

….and those coloreds (men and womens of age) are to be restricted the People of One Book and lost of souls ….shall be prohibited from voting, holding public office, practicing law, medicine, or teaching in any class above the grade of grammar school, and they shall be taxed 100 per cent of all sums in excess of $10,000 per family per year which they may earn or in any other manner receive.

A crowded underground space filled with people wearing military uniforms, looking solemn and attentive.

In order, however, to give the most sympathetic aid possible to all…. 

There was a certain discontentment among people who had once owned motorcars and bathrooms and eaten meat twice daily, at having to walk ten or twenty miles a day, bathe once a week, along with fifty others, in a long trough, get meat only twice a week—when they got it—and sleep in bunks, a hundred in a room.

Yet there was less rebellion than a mere rationalist like Walt Trowbridge, Windrip’s ludicrously defeated rival, would have expected, for every evening the loudspeaker brought to the workers the precious voices of Windrip and Sarason, Vice-President Beecroft,

A crowded, dimly lit room with multiple rows of beds. Several shirtless individuals are clustered around a narrow, water-filled channel in the center, appearing anxious and somber.

Secretary of War Luthorne, Secretary of Education and Propaganda Macgoblin, General Coon, or some other genius, and these Olympians, talking to the dirtiest and tiredest mudsills as warm friend to friend, told them that they were the honored foundation stones of a New Civilization, the advance guards of the conquest of the whole world.

They took it, too, like Napoleon’s soldiers. And they had the Jews and the Negroes to look down on, more and more. The M.M.’s saw to that. Every man is a king so long as he has someone to look down on… Constantly, in the Informer, he criticized the government but not too acidly. (Chapter 17.)

A crowded dining hall with rows of men in prison-like attire sitting at long tables, each holding a bowl of food. The atmosphere is somber, with a megaphone positioned at the end of the table and bunk beds visible in the background.

The hysteria can’t last; be patient, and wait and see, he counseled his readers.
It was not that he was afraid of the authorities. He simply did not believe that this comic tyranny

could endure. It can’t happen here, said even Doremus—even now…

Three women in a kitchen smiling while preparing food, with one holding a dish covered in paper.

It is further so ordered; All women now employed shall, as rapidly as possible, except in such peculiarly feminine spheres of activity as nursing and beauty parlors, be assisted to return to their incomparably sacred duties as home-makers and as mothers of strong, honorable future Citizens of the….”

A professional woman with long brown hair and a friendly smile, wearing a black blazer against a dark background.
BARBARA MARINO, MD PAINSPECIAL, OB-GYN ONCOLOGY SURGEON SHE AND FAMILY BRUTALLY ATTACKED BY DEA-DOJ SWAT-TEAM INTIMIDATION IS AWAITING TRIAL AND IS PREVENTED FROM WORKING AS A DOCTORS BY THE TRIAL JUDGE. “SHE SPEAKS OUT
Claudia Merandi: Pain Advocate

(5) Annual net income per person shall be limited to $500,000. No accumulated fortune may at any one time exceed $3,000,000 per person. No one person shall, during his entire lifetime, be permitted to retain an inheritance or various inheritances in total exceeding $2,000,000. All incomes or estates in excess of the sums named shall be seized by the Federal Government for use in Relief and in Administrative expenses….it is so hereby ordered.

from the doctrine of Senator Berzelius “Buzz” Windrip

“The DEA’s War on Pain Doctors and Our Individual Liberties”
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Frank Zappa
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BE SURE TO DONATE TO THE MARK IBSEN GOFUNDME DEFENSE FUND, WHERE THE SON ALWAYS RISES!!!

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References

Detailed Briefing Document: Review of “Weaponizing Policy and Debunking Opioid Myths”

This briefing document summarizes the main themes and important information from Doctor Patient Forum (DPF) led by Claudia Merandi and presented in the provided excerpts, focusing on the critique of current opioid policy, the role of specific individuals and organizations, and the debunking of commonly cited statistics.

Overall Theme:

The central theme is that current opioid policy in the United States is not based on sound science or evidence, but rather is driven by flawed metrics, misleading narratives, political agendas, and financial incentives, resulting in significant harm to pain patients and the medical profession. The DPF material argues that these policies are being “weaponized” against patients and providers.

Key Areas and Most Important Ideas/Facts:

1. The Role of Dr. Timothy E. King (T.E.K.) and the “Lost League of Pain Care Medicine”:

  • The excerpts strongly criticize Dr. Timothy E. King, MD (T.E.K.), labeling him as a figure who represents a return to “primitive” and fraudulent practices in pain care medicine.
  • He is associated with the “Lost League of Pain Care Medicine” and is described as a charismatic but ultimately deceptive individual, likened to a “sawed-off museum model of a medicine-show ‘doctor'” and a “Hoosier Demosthenes of Mystical Medical Science.”
  • T.E.K. is accused of assisting “The Government Men of Legal Mines and Statue aka the Company” in actions that harmed patients by discouraging them from seeking appropriate medical care.
  • His assertions that opioid prescriptions should be deemed illegitimate without objective evidence of functional improvement are highlighted as a key example of his flawed approach, as it “fails to account for the inherently subjective nature of pain.”
  • He is explicitly called the “RAT KING,” a “testament to the depths to which certain individuals will sink to satisfy their personal agendas.”
  • The source material frames him as an “actor of genius” who could manipulate audiences with figures and facts that were “entirely incorrect.”

2. Debunking the “MME Limits Are a Scientific Concept” Lie:

  • This is a major focus of the provided text, arguing that Morphine Milligram Equivalent (MME) limits are not based on science.
  • Key Fact: MME was originally intended as a rough estimation tool for converting between different opioids during rotation, not for risk assessment, dosing caps, or policy triggers.
  • Important Idea: MME limits have been “weaponized” across healthcare, law, and insurance to justify harmful denials, surveillance, tapering of stable patients, and DOJ investigations of doctors.
  • Key Fact: There is no single, standardized MME formula; different agencies, PDMPs, and providers use varying calculations, often without transparency.
  • Key Fact: The widely used 90 MME limit is not evidence-based. It originated from a 2007 Washington State guideline based on “opinion, not data.”
  • Key Fact: The FDA explicitly rejected a 100 MME threshold in 2013, stating “The scientific literature does not support establishing a maximum recommended daily dose of 100 MME.”
  • Key Fact: The CDC included a threshold in its 2016 guideline despite the FDA’s rejection, and it was widely misused.
  • Key Fact: The CDC revised its guidelines in 2022, walking back these limits, but systems, insurance rules, and legal precedent still adhere to the 2016 caps, leading to “patient abandonment and harm.”
  • Important Idea: MME has transitioned from a clinical estimation tool to a “blunt instrument” and a “regulatory weapon.”
  • Quote: “MME is a made-up metric that was never scientifically validated… It’s being used far beyond its intended scope.” – ACSH 2025
  • Quote: “We’re using MME as the basis for prosecution, policy, coverage, and clinical judgment — even though: …There is no universally accepted formula. Yet these numbers are still being used to deny care and prosecute providers.”
  • Key Fact: The NIH HEAL Initiative introduced a new standardized MME calculator in 2024, but explicitly states it is for “research only” and “should not be used in healthcare settings,” further highlighting the misuse of MME in clinical and policy contexts.
  • Quote: “MME was meant to be a rough estimate — not a judge, jury, and executioner.”

3. The Real-World Consequences of MME Misuse:

  • Millions of patients have been forcibly tapered, denied care, or abandoned based on MME numbers never intended for individual care.
  • Patients are labeled “high risk” based on arbitrary thresholds.
  • Doctors fear disciplinary action, lawsuits, or arrest for prescribing above arbitrary MME limits.
  • This has led to patients being pushed towards “alternatives that don’t work for them, or worse — toward illicit street drugs.”
  • Medical care has been criminalized, with doctors prosecuted for “high-dose” prescribing even when following accepted standards.

4. Weaponization of MME by the DOJ and Law Enforcement:

  • “High MME” is treated as a proxy for criminal behavior, despite the lack of scientific support.
  • The DOJ has cited “high MME” prescribing as a “red flag” in criminal indictments and civil cases, including a lawsuit against major pharmacy chains.
  • Quote: “Pharmacists filled prescriptions for opioids exceeding 90 or 120 MME per day — doses that were inconsistent with legitimate medical practice and indicative of diversion or abuse.” – DOJ Lawsuit (2021)
  • Important Idea: This approach allows agencies to “sidestep medical nuance,” “ignore patient outcomes,” and “substitute math for medicine.”

5. Selective Use of MME and Policy Hypocrisy:

  • MME thresholds are rigidly enforced in pain care but often ignored for medications used in opioid use disorder (OUD) treatment, particularly buprenorphine (Suboxone), even though it is an opioid.
  • Important Idea: This creates a “double standard” that punishes pain patients while granting flexibility to addiction medicine.
  • The source argues this is “not about safety” but about a “narrative” that promotes certain medications and policies while restricting others.
  • Quote: “It’s Not About Safety. It’s About Narrative.”

6. Debunking the Lie: “80% of Heroin Users Started with a Prescription from Their Doctor”:

  • This statistic is identified as a harmful myth used to justify restrictive policies and fuel litigation.
  • Key Fact: The “80%” figure comes from a 2013 SAMHSA report that referred to nonmedical use of prescription opioids, not prescriptions from doctors. Nonmedical use includes obtaining pills from friends, family, or dealers, or using them in ways not intended by a prescriber.
  • Quote: “Nearly 80 percent of recent heroin initiates had previously used prescription pain relievers nonmedically.” — SAMHSA, 2013 (The actual quote)
  • Important Idea: The myth conflates “misuse” of prescription opioids with “medical use under a doctor’s care.”
  • Key Fact: According to a 2016 SAMHSA report, over 53% of people who misused pain relievers got them from friends or relatives, not a healthcare provider.
  • Key Fact: Research suggests that “heroin use is rare in people who use prescription opioids as directed, even among those with long-term medical use.” – NIDA Research Report
  • Key Fact: As of 2015, data shows that 32% of people with OUD initiated with heroin, not pills. Today, illicit fentanyl is the primary driver of overdose.
  • Important Idea: Changes in language (replacing “drug abuse” with “misuse”) and diagnostic criteria (DSM-5 and Substance Use Disorder) have blurred the lines, making it easier to mislabel people and inflate statistics.
  • Quote: “Our findings suggest that the new OUD criteria may lead to a high rate of false positives when applied to patients maintained on chronic opioid therapy.” – Cicero et al., 2017
  • Important Idea: Inflated statistics have “Fueled Profit and Litigation,” benefiting addiction treatment companies, litigation firms, and agencies receiving settlement funds.
  • Important Idea: This false narrative has led to “widespread patient abandonment, stigma, and suicide—not because of addiction, but because people in pain were treated like they had an addiction.”
  • Important Idea: Iatrogenic addiction (addiction caused by medical treatment) is real but rare (estimated 0.6% to 8%).
  • Important Idea: The source argues that using the rare cases of iatrogenic addiction to justify blanket restrictions is “misusing tragedy to justify harm” and is “exploitation.”
  • Quote: “The ‘80%’ statistic is not only misleading—it’s outdated.”

7. Debunking the Lie: “Cancer Pain is Different from Non-Cancer Pain”:

  • This is another major lie that the source debunks, arguing there is no scientific basis for this distinction.
  • Key Fact: There is “no scientific or physiological difference in how opioids treat cancer vs. non-cancer pain.”
  • Key Fact: The cancer vs. non-cancer distinction was “invented by PROP and others to support restrictive opioid policies and litigation.”
  • Key Fact: The FDA explicitly rejected this distinction in 2013, stating “FDA knows of no physiological or pharmacological basis upon which to differentiate the treatment of chronic pain in cancer patients from the treatment of chronic pain in the absence of cancer.”
  • Quote: “A patient with pain from a cancer etiology has no different physiology than a patient with pain of non-cancer etiologies.” – Schatman & Peppin, 2016
  • Important Idea: The distinction persisted not because it was medically valid, but because it was “politically and legally useful” to justify restrictions, insurance denials, and prosecutions.
  • Important Idea: The rise of “cancer pain” as a policy term in the literature was a “politically motivated shift, not a scientific one.”
  • Important Idea: The source argues the underlying meaning of the distinction could be interpreted as indifference to suffering in non-cancer pain patients.
  • Quote: “When it comes to cancer and non-cancer pain, one really must question why we are drawing a distinction between these two entities — and whether it is science or politics that demands there be a difference.” – Pain Medicine, 2016
  • Important Idea: The real-world harm is that even cancer patients are now being denied opioids due to the pervasive fear and restrictive policies.
  • Quote: “Pain is pain.”

8. Broader Societal and Political Critique:

  • The source material includes unsettling excerpts from what appears to be a fictional or historical text (“Doctrine of Victory from the Lost League of Pain Care Medicine,” “Book of Russo,” “doctrine of Senator Berzelius “Buzz” Windrip”).
  • These excerpts contain disturbing and discriminatory language regarding “coloreds” and women, suggesting a underlying critique of authoritarian or discriminatory tendencies potentially linked to the figures and policies being discussed.
  • The inclusion of Frank Zappa and Albert Einstein quotes (the latter about human stupidity) adds a tone of social commentary and critique.
  • The mention of Barbara Marino, MD, an OB-GYN Oncology Surgeon “brutally attacked by DEA-DOJ SWAT-TEAM intimidation” and prevented from working, highlights the perceived aggression and overreach of law enforcement in this context.
  • The mention of “Annual net income per person shall be limited to $500,000” and confiscatory taxes suggests a critique of potential motivations or consequences of the policies being discussed, potentially linking them to economic control or redistribution under a specific ideology.
  • The mention of the Washington Legal Foundation’s prediction about the CDC guidelines being used in opioid litigation highlights the awareness of the legal and financial implications of these policies.

Conclusion

(as reflected in the source’s tone and call to action):

The provided excerpts paint a picture of a system where flawed data, misleading narratives, and political agendas have led to the “weaponization” of policies like MME limits and the cancer vs. non-cancer distinction.

@cmerandi1

DPF Consultants, LLC, founded by Claudia A. Merandi and Bev C. Schechtman, leverages expertise in healthcare education, digital influence, and advocacy to drive meaningful change. Claudia A. Merandi – Advocate and educator whose efforts led to a Rhode Island law protecting pain management access, and whose audience has grown exponentially since 2016 as she continues to expose systemic harms faced by patients and providers. Bev C. Schechtman – Researcher, advocate, and educator who exposes the harms of opioid reduction policies and surveillance tools like PDMPs and NarxCare, and empowers patients with the tools and knowledge to navigate today’s healthcare system amid the opioid reduction movement.

♬ original sound – Claudia A. Merandi

This has resulted in significant harm to patients in pain, the criminalization of medical care, and a general climate of fear and mistrust within the healthcare system.

The source DPF, calls for an end to these practices and a return to evidence-based, patient-centered pain care.

The included discriminatory excerpts suggest a deeper concern about the potential for such policies to be rooted in or lead to broader societal control and discrimination.

Detailed Timeline of Main Events

  • Pre-Mid-2000s: Pain treatment guidelines historically did not differentiate between “cancer” and “non-cancer” pain.
  • Mid-2000s: Public health discourse begins to shift, with terms like “cancer pain” and “non-cancer pain” becoming more common in literature and policy discussions, driven by political rather than scientific motivations.
  • 2007: Washington State’s Agency Medical Directors’ Group (AMDG) releases the “Interagency Guideline on Opioid Dosing for Chronic Non-Cancer Pain,” which is among the first significant documents to introduce a formal split between cancer and non-cancer pain. It also includes an early MME dose limit of 120 MME/day and suggests a 90-day limit for chronic non-cancer pain.
  • 2012: The advocacy group PROP (Physicians for Responsible Opioid Prescribing), led by Andrew Kolodny, submits a citizen petition to the FDA requesting label changes for opioids, specifically for non-cancer pain. The petition proposes removing the word “moderate” from opioid indications, capping daily doses at 100 MME, and adding a 90-day limit for continuous use.
  • May 2012: The NIH holds a workshop on opioid labeling in response to the PROP petition.
  • February 2013: The FDA holds a public hearing regarding the PROP petition. Various groups, including the American Society of Anesthesiologists (ASA), Dr. Bob Twillman, and the American Cancer Society, voice objections to the cancer vs. non-cancer distinction.
  • 2013: The Substance Abuse and Mental Health Services Administration (SAMHSA) releases a report stating that “Nearly 80 percent of recent heroin initiates had previously used prescription pain relievers nonmedically.” This statistic is subsequently widely misinterpreted and misused to claim that 80% of heroin users started with a prescription from their doctor.
  • September 2013: The FDA responds to the PROP petition, explicitly stating that there is “no physiological or pharmacological basis upon which to differentiate the treatment of chronic pain in cancer patients from the treatment of chronic pain in the absence of cancer.” The FDA declines to specify or recommend a maximum daily dose or duration of use for any opioid at that time, rejecting the 100 MME cap proposal.
  • 2016:The CDC releases its guideline on opioid prescribing, which states that opioids should be reserved for “pain outside of active cancer treatment, palliative care, and end-of-life care.” It also includes 90 MME as a recommended threshold for daily dosage, suggesting patients above this level may benefit from closer monitoring, reduction, or tapering. The guideline has an aggressive implementation strategy.
  • Richard Samp of the Washington Legal Foundation predicts that the CDC’s new opioid guidelines will be used in opioid litigation.
  • A SAMHSA short report indicates that among people who misused prescription pain relievers in the past year, over 53% obtained them from friends or relatives, and only 37.5% got them from a healthcare provider.
  • A Pain Medicine article challenges the cancer vs. non-cancer distinction as a “distinction without a difference.”
  • Pain experts Dr. Michael Schatman and Dr. Brian Peppin publish an article arguing that the cancer vs. non-cancer split has no medical basis and urging abandonment of these biased categories.
  • NIDA publishes a research report stating that heroin use is rare in people who use prescription opioids as directed.
  • Nejm.org publishes an article by Volkow & McLellan on Opioid Abuse in Chronic Pain, noting that the risk of addiction during chronic opioid therapy is generally low (0.6% to 8%).
  • After 2016:More than half of U.S. states codify the 90 MME threshold from the 2016 CDC guideline into law or medical board rules.
  • Electronic Health Records (EHRs) and Prescription Drug Monitoring Programs (PDMPs) integrate MME thresholds, flagging patients and doctors based on these metrics.
  • Insurers frequently use MME thresholds to deny coverage or trigger prior authorization.
  • The Department of Justice (DOJ) and law enforcement agencies begin using “high MME” prescribing as a red flag and evidence of wrongdoing in criminal indictments and civil cases.
  • Patients with long histories of stable opioid therapy are forcibly tapered, denied care, or abandoned.
  • Doctors face disciplinary action, licensing penalties, or criminal prosecution for exceeding MME limits, even without patient harm.
  • The misinterpreted “80% stat” is used to justify restrictive policies, push pain patients off medication, expand Suboxone markets, and win legal settlements based on inflated addiction statistics.
  • 2017: A study by Cicero et al. suggests that the new OUD criteria in DSM-5 may lead to a high rate of false positives when applied to patients on chronic opioid therapy.
  • 2018: Politico Magazine reports that the SAMHSA data shows people used opioids “somehow” before trying heroin, not necessarily through a doctor’s prescription. A NIDA Research Report reiterates that heroin use is rare in people who use prescription opioids as directed.
  • 2019: An analysis by Cicero et al. in Addictive Behaviors finds that by 2015, the percentage of individuals entering treatment for heroin use who reported initiating opioid use via prescription drugs had declined significantly since the early 2000s, with 32% first using heroin.
  • 2021: In the civil case United States v. Walmart Inc., CVS Health Corp., and Walgreens Boots Alliance, the DOJ cites filling prescriptions exceeding 90 or 120 MME per day as evidence of unlawful conduct.
  • 2022: The CDC releases a revised guideline on opioid prescribing, which walks back some of the rigid limits and language of the 2016 guideline. However, there is no comprehensive de-implementation plan, and the 90 MME cap continues to be used in systems, insurance rules, and legal precedent.
  • 2023: A JAMA Network Open study highlights oncologists’ views on challenges in opioid prescribing for cancer pain.
  • 2024:The NIH HEAL Initiative releases a new standardized MME calculator, but explicitly states it is “for research only” and should not be used in healthcare settings, policy, or law.
  • An NIH HEAL Initiative webinar acknowledges the inconsistency and limitations of existing MME data.
  • A UW Blog and other 2024 studies suggest that opioid access is declining, even for cancer patients, and ER visits for pain may be rising.
  • The case of April, a terminal cancer patient denied opioids at a pharmacy despite being in palliative care, highlights that even cancer patients are now being impacted by prescribing restrictions.

Cast of Characters

  • Dr. Timothy E. King, MD (T.E.K.): Also referred to as the “Rat King.” Described as a figure from the “Lost League of Pain Care Medicine.” The sources portray him critically, linking him to past “medicine-show” type activities and presenting him as an advocate for policies (like deeming opioid prescriptions illegitimate without objective functional improvement) that are characterized as detrimental and based on “bogus economics.” He is described as a charismatic and overwhelming actor who uses potentially incorrect figures and facts.
  • Norman J. Clement, KPH, DDS: A source author from youarewithinthenorms.com who critically references Dr. Timothy E. King.
  • Bob Sheerin: A “Pain Care Advocate” who shared a TikTok video referenced in the source, linking Dr. King to the “Lost League of Pain Care Medicine.”
  • Albert Einstein: The renowned physicist, quoted at the beginning of one of the source excerpts with the saying, “Two things are infinite: the universe and human stupidity; and I’m not sure about the universe.” This quote is used in the context of criticizing Dr. Timothy E. King.
  • Claudia Merandi: A “pain advocate” associated with the Doctor Patient Forum group. The source attributes her group to “Debunking the Lie: ‘80% of Heroin Users Started with a Prescription from Their Doctor’.”
  • Assistant U.S. Attorneys: Referenced in “The Book of Russo” as hilariously attempting to explain the “Standard and Scope of Practice” of medical sub-specialties in criminal cases, suggesting a lack of understanding of complex medical fields by legal professionals involved in opioid prosecutions.
  • FBI Special Agents: Also referenced in “The Book of Russo” alongside Assistant U.S. Attorneys, participating in legal proceedings related to opioid cases and described as having a poor understanding of medical practice.
  • Andrew Kolodny: President of PROP (Physicians for Responsible Opioid Prescribing). He is identified as a key figure in advocating for restrictive opioid policies, including signing the 2012 petition to the FDA proposing dose and duration limits for non-cancer pain. He is also noted as a consultant for a plaintiffs firm involved in opioid litigation.
  • Anna Lembke: Identified as an “expert witness in opioid litigation” and a signer of the PROP petition to the FDA.
  • Jane Ballantyne: Identified as an “expert witness in opioid litigation” and a signer of the PROP petition to the FDA.
  • Roger Chou: Identified as the “lead author of both CDC guidelines” (presumably the 2016 and 2022 guidelines) and a signer of the PROP petition to the FDA.
  • Dr. Tom Frieden: Mentioned as the recipient of a letter from the American Academy of Anesthesiologists (ASA) in 2016 commenting on the proposed CDC guidelines.
  • Dr. Bob Twillman: A pain expert referenced as questioning the definition of “non-cancer pain” during the FDA public hearing in 2013.
  • Richard Samp: From the Washington Legal Foundation. He is quoted as predicting in 2016 that the CDC Guidelines would be used by the “plaintiffs bar” in opioid litigation.
  • Dr. Meredith Adams: From the NIH HEAL Initiative. She is quoted in a webinar unveiling the new research-only MME calculator, acknowledging the limitations of existing data.
  • Barbara Marino, MD: Described as a “PainSpecial, OB-GYN Oncology Surgeon.” The source states she and her family were “brutally attacked” by a DEA-DOJ SWAT team and that she is awaiting trial and prevented from working by the trial judge.
  • Senator Berzelius “Buzz” Windrip: A fictional character mentioned in the context of a “doctrine” that proposes discriminatory and restrictive policies against certain groups of people (“coloreds,” “People of One Book,” “lost of souls”) and limits income and accumulated fortune. This appears to be a historical or literary reference used to draw parallels to restrictive or harmful policies discussed in the source.
  • Frank Zappa: The musician is mentioned in the title “The DEA’s War on Pain Doctors and Our Individual Liberties,” suggesting his music or philosophy might be relevant to the themes of government overreach and individual freedom.

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