States and Status of Legislation Protecting CPP's and Providers:

• Arizona  - Signed into law
• Colorado  - Signed into law
• Illinois HB 2046 - In Committee
• Minnesota  - Signed into law
• New Hampshire - Signed into Law
• Oklahoma Bill SB57 - Signed into Law
• Rhode Island Bill 384 - Signed into Law

Watch Claudia interview Bev Schechtman about her experience in the hospital when she was denied pain medication for kidney stones due to being a victim of sexual abuse.  

"Everything is looked at as drug-seeking.  No matter we do, they think we're drug-seeking." ~ Bev Schechtman

"We are taking on this fight for you. I've heard your voice and I've put it into the briefs we submitted." ~Atty Ron Chapman

We posted an article last week about the Supreme Court case coming up on March 1, 2022. On Jan 4, Claudia interviewed Ron Chapman, who submitted an Amicus Brief in support of the doctors in this case.  Ron broke it down for us explaining what this means for CPP's and doctors. Listen to the interview to find out what Ron thinks the best and worst case scenarios are depending on the outcome of this hearing.

Summary of the issue

• Under the Controlled Substance Act (CSA), the criminal standard for prescribing says a physician can't prescribe outside the course of professional practice other than for a legitimate medical purpose, When a doctor elects to prescribe a medication, he needs to make sure he establishes a physician patient relationship and that the prescription is for a legitimate medical need. That should be the extent of the discussion. Courts should not debate about whether it's the right or effective treatment. All the court should ask is if the doctor was acting like a doctor and if he was, then it should be done, acquitted. No conviction.
• Over the last ten years the federal government has decided to crack down on opioids. They took out pill mills because there were bad doctors. So they hired a bunch of prosecutors and DEA agents, and they started going after these doctors. Once the government ran out of nails (doctors) to hammer and already had all these hammers (DEA agents/prosecutors), it needed more nails to go after. So, they started asking judges and juries to decide closer and closer calls in the practice of medicine, so more doctors would be caught up in its net. This started around 2011.They hired experts to get on the stand and say "here is what the standard is, and if you don't do what I think you should do then you're committing a crime." They got on the witness stand and started spouting their theories of what doctors should and shouldn't do.
• In 2016 the federal government decided to take these theories of expert witnesses and they codified them in the CDC Guidelines. Now federal courts are using the Guidelines to convict physicians. The problem is there is no consensus on how a physician should prescribe, it's patient specific and can't be reduced to these ideas. The idea that it can is nonsense.

Episode 17- 2/2/23

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

Please join Arizona's Don't Punish Pain Rally page to network with other CPP advocates from Arizona

In April of 2022, Arizona passed a law, Bill SB1162,  protecting pain patients. 

Dr. Jeffrey Singer testified if favor of the bill

Governor Doug Ducey Signs SB1162 into Law Helping Arizonians with Chronic Intractable Pain Get the Treatment They Need

Senator Nancy Barto introduced Arizona SB1162 in January 2022. This new law will give protections to chronic intractable pain patients in Arizona. This amendment to ARS Section 32-3248.01, will improve access to care, give physicians the ability to treat their patients as medically appropriate, and confirm that providers and their state governing boards have oversight on the proper treatment for these patients.

Episode 3 - 8/29/22

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"Interview with attorney Ron Chapman about the targeting of the doctors by the DEA"

Read our FAQ's on NarxCare and our NarxCare article, If you need a little refresher on what it is. 

As you know, one of our issues with NarxCare is that it has never been externally validated. Bamboo Health/Appriss held a webinar on October 27, 2021. The webinar was named "External Validation of NarxCare as Useful Clinical Decision Support Tool." Here is a recording in case you're interested in watching the 30-minute webinar. They state the aim of the paper the webinar was based on is to "validate the NS metric compared to WHO ASSIST and identify high, moderate and low opioid risk thresholds and to provide actionable data."

Before I go into detail about this webinar, I want to tell you a story about a hypothetical patient named Rachel. 

Rachel has had the same prescriber for years, but is moving across the country and has to find a new doctor.  According to Rachel's Narcotic Score (NS), Rachel now has two prescribers. This new doctor has a PA in his office that sometimes writes Rachel's prescriptions. Rachel now has 3 prescribers within the last two years. Six months after Rachel started seeing this new doctor, he is raided by the DEA and can no longer prescribe. Rachel finds a new doctor. She now has had 4 prescribers. Rachel's new doctor gives her the first two prescriptions and then transfers her to his NP. This would be Rachel's 5th prescriber. Sadly,18 months after Rachel moved, she is in a terrible car accident and is admitted to the hospital for 4 weeks. Upon discharge, the nurse has Rachel's prescriptions filled at the hospital pharmacy for Rachel so she doesn't have to stop on the way home. This would now be a 6th prescriber. According to the PDMP and NarxCare, she will be flagged as a doctor shopper.

Let's talk about Rachel's pharmacies. Once Rachel moves, she obviously has to get a new pharmacy. Rachel now has 2 pharmacies showing in the PDMP. Rachel's new pharmacy is CVS. CVS starts to give Rachel a hard time about getting her prescriptions filled and her doctor suggests she start going to a small mom and pop pharmacy. Rachel now has 3 pharmacies listed in her PDMP NarxCare score. After a few months, her current pharmacy tells Rachel that due to DEA quota cuts, they can't keep filling her meds consistently and suggests she go to a different, larger pharmacy. Rachel does, and now has 4 pharmacies listed in her PDMP. Remember Rachel's terrible car accident she was in? The pharmacy at the hospital would be Rachel's 5th pharmacy in the past two years. According to her Narcotic Score, she will be flagged as a pharmacy hopper.

After Rachel's nearly fatal car accident, she is given a prescription for sleeping pills because she has a really hard time sleeping. She also is given 10 Ativan because she has PTSD from her accident and gets panic attacks every time she gets in the car to drive to PT. Both of these medications increase her NarxCare Narcotic Score even though they aren't opioids.

Rachel sees her doctor after being discharged from the hospital and he tells her that her Narcotic Score is too high and he can no longer prescribe. Her NS skyrocketed bc she had 6 prescribers, 5 pharmacies, a prescription for sleeping pills and a prescription for Ativan. The only medication her doctor is now willing to prescribe is Suboxone, which means she would now have a diagnosis of Opioid Use Disorder in her EHR. Rachel declines and thankfully, she is able to find a new pain doctor. Her NS now shows she has had a total of 7 prescribers in the last 2 years. Her new doctor receives a warning letter because he is prescribing controlled substances to someone with a very high NS. Rachel's new doctor dismisses her from his office saying he's not willing to risk his license for her. Not only is Rachel unable to find a new pain doctor, she can't even find a regular doctor.

So, was this Narcotic Score helpful?  In black and white it looks like Rachel is playing games and has definite signs of OUD. The reality is, she doesn't struggle with addiction, but is now medically abandoned and her only option for pain relief is to go to the streets and hope to get pills that aren't laced with illicit fentanyl. Since Rachel is too afraid to do that, she has to quit her job and file for SSDI since she is no longer able to work due to uncontrolled pain and anxiety.

Now let's discuss this webinar.

Episode 15 - 12/9/22

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Listen to this informative and riveting interview.

Learn all about the anti-opioid zealots and how their lies have caused suffering and deaths.

"Americans have been bamboozled into believing that prescription opioids are causing the opioid epidemic." ~Claudia Merandi

Episode 38 - 11/16/23

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Show Notes

We interview Dr. Stanton Peele and Zach Rhoads about addiction, Suboxone, pain patients, Harm Reduction, and more! You won't want to miss this episode.

Dr. Stanton Peele is a psychologist who has pioneered, among other things, the idea that addiction occurs with a range of experiences and recognition of natural recovery from addiction. He developed the ⁠Life Process Program⁠ for addiction. He has authored many books since the 1975 publication of ⁠Love and Addiction⁠ (co-authored by Archie Brodsky); his latest is ⁠A Scientific Life on the Edge: My Lonely Quest to Change How We See Addiction⁠.

Zach Rhoads- Zach is a behavior specialist in Vermont schools and his school's PBiS (Positive Behavior Interventions and Supports) coordinator. Zach is a counselor and family systems developer for the online Life Process Program - an addiction coaching program developed by psychologist Dr. Stanton Peele. He also writes articles about health and drug policy for Filter Magazine and is coauthor (with Dr. Stanton Peele) of the book, Outgrowing Addiction. (He is currently working on a forthcoming book about student-led education in the United States). Zach believes that community collaboration and cohesion is a bulwark against many forms of mental illness and addiction, and helps people find these resources in ways that makes sense in their own lives.

The Doctor Patient Forum is a national non profit organization fighting for the rights of pain patients and their providers. We bring awareness to the untreated pain and patient abandonment crisis. We are also knows as Don’t Punish Pain Rally.

⁠https://www.patreon.com/thedoctorpatientforum

#thedoctorpatientforum  #dontpunishpainrally #chronicpain #opioids #chronicpainpatient #patientabandonment #harmreduction #chronicillness #medicalgaslighting #dpfpatreon #pain #opioideliminationindustry #opioidelimination #patreon #thedoctorpatientforumpatreon #harmreduction #medicalgaslighting

The information in this podcast is not to be considered medical or legal advice

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

An article in Reason came out yesterday about the ruling for the Defendants (four drug companies-Teva, Johnson & Johnson, AbbVie, and Endo) in opioid litigation. This is huge for our community. The Judge said the  Plaintiffs failed to prove the charges of public nuisance and false advertising. Superior Court Judge, Peter J. Wilson wrote a 42 page ruling. This was the first of thousands of cases filed across the country regarding the "opioid crisis," filed in 2014. The Plaintiffs' claims were:

1. The companies used false advertising
2. They engaged in unlawful business practices
3. They created a public nuisance

Judge Wilson ruled the Plaintiffs failed to prove any of these claims. Some direct quotes from Judge Wilson's ruling:

CPP advocates in Minnesota have been working hard to pass legislation to protect intractable pain patients. 

Video of hearing on March 24, 2022. A CPP and Dr. Beth Darnall testified.

Minnesota Stat. 152.125 - intractable pain 

Episode 13 - 10/31/22

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This is part 4 in our NarxCare/PDMP series. We interview Jacob James Rich. This episode focuses on PDMP harms, law enforcement's access to the PDMP, and whether HIPAA protects patients from PDMP data being shared.

Jacob James Rich is a researcher. Jacob also works as an analyst for Reason Foundation, focusing on healthcare policy. He has written extensively on drug policy topics, such as the consequences of prescription drug monitoring programs (PDMPs) on patient access and overdose mortality. Jacob is currently researching racial disparities in drug enforcement with CWRU Graduate Student Council's DEI Award.

Brief: https://reason.org/policy-study/prescription-drug-monitoring-programs-effects-on-opioid-prescribing-and-drug-overdose-mortality/

Reason bio page: https://reason.org/author/jacob-rich/

Twitter: @jacobjamesrich

Attorney Jennifer Oliva's article on PDMP and law enforcement in Duke Law Review - Prescription Drug Policing: The Right to Health Information privacy Pre- and post-Carpenter 

Links to topics mentioned:

1. Opioid Rapid Response Program content on The Doctor Patient Forum Website
2. OIG Toolkit

Links to podcasts or presentations in their entirety that were shared in this podcast - 

1. NASCA - "State PDMP vs National PDMP"
2. Cover 2 Resources - "Strike Force Stops Flow of Illicit Opioids"
3. Cato Institute - "Patients, Privacy, and PDMP's"
4. NPR show 1A - "Against the Pain - The Opioid Crisis and Medication Access"

Kate Nicholson's bio - "Kate Nicholson, JD, is a civil rights attorney and a nationally-recognized expert on the Americans with Disabilities Act (ADA). She served in the U.S. Department of Justice for 18 years, where she litigated and managed cases, coordinated federal disability policy, and drafted the current ADA regulations." - Executive Director at NPAC

Kate developed intractable pain after a surgical mishap left her unable to sit or stand and severely limited in walking for many years. She gave the TEDx talk, What We Lose When We Undertreat Pain, and speaks widely at universities and conferences and to medical groups."

Disclaimer: The information provided to you in this podcast is not to be considered medical or legal advice.

Please join New Hampshire's Don't Punish Pain Rally Facebook page to network with other advocates from NH.

New Hampshire’s Bill, HB1639, was signed by Governor Sununu in August of 2020. It was originally created as a separate bill, SB 546, but was later added to Omnibus Bill HB1639. 

The bill was created and passed with the amazing efforts of Bill Murphy, CPP advocate and original member of Don't Punish Pain Rally. When the bill was signed into law, Bill Murphy created this tweet: 

"New Hampshire’s Bill, HB1639, has been signed by Governor Sununu. This Bill addresses the “Treatment of Chronic Pain”. Key sections of this legislation are attached"

NPR's show, 1A, had our VP, Bev Schechtman on a panel on November 11, 2021. The name of the segment is "Against The Pain: The Opioid Crisis and Medication Access." NPR became interested in the show after reading Maia Szalavitz's article about NarxCare in Wired.  Listen to the recording of the show.  You don't want to miss this!  

"We have these people who have been on these meds for 20-30 years and doctors are under extraordinary pressure to get their numbers down" ~Maia

"In a criminalized environment where doctors are not only afraid of losing their license, but of going to prison, and where patients are being squeezed because they're being told 'you can only have x amount because otherwise my numbers are too high,' you end up with a lot of untreated pain." ~Maia

"I'd like to see context added (to these algorithms), if someone moves 3 times in 2 years, it needs to not look like they're 'doctor shopping,' I'd like to see a return to individualized care and stop these arbitrary guidelines where people are having a hard stop on what they can and can't have and they're not looking at what's actually going on with the patient." ~Bev

"I was treated like a criminal; I was mocked, laughed at, scolded, I was embarrassed...I felt revictimized." ~Bev

"There are tremendous gender and racial bias in these algorithms and in this false narrative." ~Bev

"No one should ever be denied care, that's just cruel and unusual punishment." ~Dr. Dombrowski

"Electronic Health Records are just a billing system, not to make patient care better...if you hit something by accident like malingering, next thing you know it's in the chart permanently. It's dangerous." ~Dr. Dombrowski

Dr. Mark Ibsen, who is a fierce advocate for the CPP community, recorded the show with running commentary.  

Please join Oklahoma's Don't Punish Pain Rally Facebook page to network with other CPP's in Oklahoma

Oklahoma's Intractable Pain Bill

In April 2021 Oklahoma's Bill SB57 unanimously passed the House and Senate.

Hearing About Harms From Forced Tapers

On November 1, 2021 the Oklahoma, Alcohol, Tobacco, and Controlled Substances Committee held a hearing. The  purpose was to discuss an interim study that was done about rapid de-prescribing and the horrific effects it has had on patients.  This was requested and organized by Tamera Stewart-P3Alliance Policy Director, Julia Heath-P3Alliance Director of Medical Initiatives, along with their leadership team.

Some of the speakers were Beth Darnall ,PhD from Stanford University, Dr. Vanila Singh, other doctors, a pharmacist, and chronic pain patients.

• "We are exposing vulnerable patients to new health risks by reducing opioid prescriptions."
• "We saw increased health problems, suicidal ideation, suicides, overdose deaths as a consequence or opioid reductions themselves."
• Dr. Darnall mentions this recent Jama study on the association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids.
• We've failed to implement patient-centered care for our most vulnerable population.

"Where's the Patient's Voice in Evidence-based Treatment & Research?"

Part 4 in the series "Pharmacist and Physician Opioid Collaborative"on Pharmacy Podcast Network.

Listen as Todd Eury, from Pharmacy Podcast Network, asks Bev a question that is long overdo..."What is the patient's perspective?"

"No one ever asks the patient what we think, we are kind of shoved out of it." ~Bev Schechtman

"But what they're missing, Bev, is they're missing the empathetic bedside manner to look you in the eye and give you a sincere little smile, showing they're there for me as a patient." ~Todd Eury

"We feel like everyone around us is going to treat us as though everything we say is a lie, that we're going to try to get out of whatever it is they think they're trying to catch us in, and we can't trust any of them." ~Bev Schechtman

"The way they set up the system patients can't be honest with our providers." ~Bev Schechtman 

"

Roger Chou’s Undisclosed Conflicts of Interest: How the CDC’s 2016 Guideline for Prescribing Opioids for Chronic Pain Lost Its Clinical and Professional Integrity

By: Chad D. Kollas MD, Terri A. Lewis PhD, Beverly Schechtman and Carrie Judy

“I'm present. Uh … I do have a conflict. I receive funding to conduct reviews on opioids, and I'll be recusing myself after the um, director's, uh, um, um, uh… update.”

- Dr. Roger Chou, Center for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (NCIPC) Board of Scientific Counselors (BSC) Meeting Friday, July 16, 2021.

Introduction
For those familiar with the controversial relationship between the anti-opioid advocacy group, Physicians for Responsible Opioid Prescribing (PROP, recently renamed, Health Professionals for Responsible Opioid Prescribing), and the Centers for Disease Control’s CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016, (2) (hereafter called “the 2016 Guideline”), Dr. Roger Chou’s disclosure represented a stunning admission (3, 4). Chou had originally announced his intention to help influence opioid policy in a 2011 article that he co-authored with PROP’s founders (5), and he was a bold signatory to PROP’s 2012 Petition to the Food and Drug Administration (FDA) to change opioid labeling (6; See Figures 1a and 1b: First page and signatory page.)