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  • America in Pain; Why No One Cares. Claudia Merandi and Beth Dost, RN

    Caught up in a war against illicit Fentanyl and Heroin, 50 million Americans who suffer from chronic, daily pain have been marginalized and discarded.  

  • Cops Practicing Medicine - The Parallel Histories of Drug War I and Drug War II

    We have been screaming as loudly as we can that unless law enforcement gets out of our medical care, no amount of revisions of any guidelines will help. This is a phenomenal history this very issues.

    We will include this article in its entirety along with a PDF version that can be downloaded.

    "Government and law enforcement increasingly surveil and influence the way doctors treat pain, psychoactive substance use, and substance use disorder."

    NOVEMBER 29, 2022 • WHITE PAPER

    Link to article

    Link to interactive digital companion piece

    Downloadable PDF version

    Screenshot 206

    People have used opium and its derivatives both medically and recreationally since antiquity. However, since the early 20th century, law and society have viewed people who use opioids, cocaine, and certain other psychoactive substances as immoral and even criminal. For more than 100 years, this viewpoint has destructively intruded on the patient‐​doctor relationship. Government and law enforcement increasingly surveil and influence the way doctors treat pain, psychoactive substance use, and substance use disorder. This change has happened in two discernible waves, which we call Drug War I and Drug War II.

    Drug War I occurred after Congress enacted the Harrison Narcotics Act in 1914, which permitted doctors to prescribe opioids to treat their patients. A wave of arrests and prosecutions of thousands of doctors ensued as agents of the U.S. Treasury Department, empowered to enforce the act, took it upon themselves to define legitimate medical practice.

    Drug War II began in the 1970s, with government‐​funded education/​indoctrination campaigns that caused both doctors and patients to fear opioids for their addictive and overdose potential. Later, as the scientific literature led medical specialty organizations and government health officials to overcome this apprehension and take the treatment of pain more seriously, opioid prescribing increased considerably.

    By 2006, federal regulatory agencies perceived what they called an “opioid crisis” and mistakenly attributed it to doctors “overprescribing” opioids and generating a growing population of opioid addicts. This formed the basis for an even more massive intrusion of federal and state power into the privacy of medical records, patient‐​doctor confidentiality, and the very way in which doctors are allowed to use scientific and professional knowledge to practice medicine. Medical decision making came increasingly under the purview of law enforcement, sparking a new wave of arrests and prosecutions.

    Patients who had their pain controlled with long‐​term opioid treatment are being denied treatment or involuntarily tapered off their pain control, as doctors fear arrest and an end to their medical careers. A growing population of “pain refugees” has emerged, with some patients turning in desperation to the black market for opioids and some even turning to suicide. As prescribing rates continue to plunge, overdoses from the nonmedical use of opioids are skyrocketing, now largely caused by illicit fentanyl.

    The medical mismanagement of pain, which causes harm to patients, is best addressed through the civil tort system. Additionally, states establish professional licensing boards specifically to enforce the “standard of care” rendered by the professionals they oversee. Law enforcement has no medical expertise and should have no say in classifying narcotics and psychoactive substances. Lawmakers should avoid passing or repeal any laws that cast in stone prescribing guidelines released by any state or federal public health agencies. Federal and state law enforcement should be required to get a warrant before perusing state prescription drug monitoring program databases. Law enforcement should be required to report any suspected standard‐​of‐​care deviations to state professional licensing boards for review and adjudication. Neither the practice of medicine nor the act of self‐​medication belongs in the realm of the criminal legal system.

    “History doesn’t repeat itself,
    but it often rhymes.”

    —ATTRIBUTED TO MARK TWAIN

    Introduction

    Why do people with alcohol‐​use disorder get treatment while heroin users get put in cages or a different form of criminal punishment? This question is at the heart of our drug policies both historically and currently, and critically examining the answer will help us be more compassionate and helpful to our fellow drug‐​using human beings. We use the phrase “human being” quite deliberately. Our drug policies systematically dehumanize the users of some psychoactive compounds. Those who use heroin have been regarded as “junkies” whose drug use is more morally suspect than those who use substances such as alcohol or marijuana. That differential moralizing of different substance users is, fundamentally, why we give alcoholics treatment and heroin users criminal punishment: we tend to like alcoholics more, and more of us have personal experience with alcohol.

  • DEA Warns of Counterfeit Pill "Surge" Following its Crackdown on Prescriptions

    Truth Out published an article on October, 1, 2021 regarding the DEA's recent public safety alert about the abundance of counterfeit prescription pills. Mike Ludwig's article is part of the series "The Policing of Pain: Inside the Deadly War on Opioids." This increase demand for prescription pills is largely due to a crackdown on prescribing of controlled substances. Mike explains that the link between "overprescribing" and the overdose crisisis greatly exaggerated, citing the fact that opioid prescribing has plummeted to the lowest it has been in a decade as overdoses have skyrocketed. Claudia Merandi, Founder and President of The Doctor Patient Forum, was interviewed for this article.

  • How Can Doctors Stay Protected?

    Doctors need to have a compliance plan in place in order to stay protected when prescribing scheduled drugs. Please contact Chapman Consulting Groupwith any questions.

    "If you don't follow up on red flags you're being labeled as a criminal prescriber" ~Compliance Officer

    "The government has chosen to target doctors instead of the cartels, who are brining in the drugs that are killing people." ~Compliance Officer

  • Podcast S2 E3 - Dr Jeffrey Singer - A Surgeon's view on untreated/undertreated pain and Cops Practicing Medicine

    Season 2 Episode 3 - 2/2/23

    Link to Episode

    "Jeffrey A. Singer is a senior fellow at the Cato Institute and works in the Department of Health Policy Studies. He is President Emeritus and founder of Valley Surgical Clinics Ltd., the largest and oldest group private surgical practice in Arizona and has been in private practice as a general surgeon for more than 35 years.
    He is also a visiting fellow at the Goldwater Institute in Phoenix. Singer is a member of the Board of Scientific Advisors of the American Council on Science and Health. From 1994 to 2016, he was a regular contributor toArizona Medicine, the journal of the Arizona Medical Association. He served on the Advisory Board Council of the Center for Political Thought and Leadership at Arizona State University from 2014 to 2018 and is an adjunct instructor in the Program on Political History and Leadership at ASU. He writes and speaks extensively on regional and national public policy, with a specific focus on the areas of health care policy and the harmful effects of drug prohibition.
    He received his BA from Brooklyn College (City University of New York) and his MD from New York Medical College. He is a fellow of the American College of Surgeons."
    Links to articles discussed in this podcast episode:
    Disclaimer: The information that has been provided to you in this podcast is not to be considered legal or medical advice.
  • Supreme Court Case on March 1, 2022 Can Make All the Difference For Doctors and Patients

    On March 1, 2022, the Supreme Court will hear a case that could make or break the future for pain doctors and their patients. Pat Anson, from Pain News Network, summed it up perfectly in this article "Supreme Court Case May Decide Future of Opioid Prescribing."


    By Pat Anson, PNN Editor

    December 29, 2021

    "Over a dozen patient and physician advocacy groups have filed legal briefs with the U.S. Supreme Court in support of two doctors appealing their convictions for criminal violations of the Controlled Substances Act.

    The nation’s high court has consolidated the cases of Dr. Xiulu Ruan of Alabama and Dr. Shakeel Kahn, who practiced in Wyoming and Arizona. Both doctors were sentenced to lengthy prison terms after being convicted on a variety of charges – including the prescribing of high doses of opioid pain medication to patients “outside the usual course of professional practice.”

    Oral arguments will be heard by the Supreme Court on March 1, with a decision expected later in 2022. Monday was the deadline for interested parties to file “amicus curiae” briefs on the case, which could have a significant impact on opioid prescribing practices nationwide if the appeals are successful. Many doctors have stopped or reduced their prescribing of opioids because they fear being prosecuted under the Controlled Substances Act (CSA).

    “It is no exaggeration to say that CSA prosecutions of physicians have already impaired the treatment of chronic pain,” Ruan’s attorneys said in their appeal. “In response to the opioid crisis, fear of prosecution has increasingly prompted pain management doctors to avoid or reduce opioid prescriptions, even when those decisions leave chronic pain patients without recourse.”

    A successful appeal would mean Ruan and Kahn could ask for new trials, along with dozens of other doctors convicted of similar charges under the CSA.

    “It will also avoid what I see as the chilling effect that it’s had on lots of doctors who are not doing anything even remotely suspicious, but are afraid that they are going to get caught because they prescribe a higher dose, and so they’re dropping people from care or tapering them,” said Kate Nicholson.

    NPAC, along with other advocacy groups and the U.S. Chamber of Commerce, are asking the high court to clearly state how the practice of medicine should be regulated under the CSA. Some argued it is best left to state medical boards, not federal prosecutors or law enforcement.

    “Patients with pain, addiction, or both desperately need appropriate care and treatment. If practitioners are held strictly liable under (the CSA), patient abandonment will become ever more common as practitioners act to avoid scrutiny,” Jennifer Oliva and Kelly Dineen, professors of health law and policy, said in their brief. “Progress in medical care in these areas can only recover if the regulation of medical practice is returned to the province of the states except in narrow circumstances.”

  • You Can't Treat My Pain Because You'll Lose Your License

    Watch Claudia interview pain patient, Connie. Connie has survived breast cancer twice, 30 surgeries, and MS, yet she's had a hard time finding a doctor to treat her pain.

    "The few doctors that are brave enough (to prescribe), it's only a matter of time before they get shut down." ~Connie

    "We're seeing people in hospice, palliative care, with acute injuries, kidney stones, and nobody is being treated because of the opioid elimination industry. This is a big business; there is a lot of money in suffering." ~Claudia Merandi

The Doctor Patient Forum

Claudia A. Merandi 5 Chedell Avenue / East Providence, RI 02914 / USA 1.401.523.0426

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