Visual Feature

Cops Practicing Medicine

December 16, 2022 • Visual Feature

By Jeffrey A. Singer and Trevor Burrus

Join the Conversation

#CatoHealth

Cops Practicing Medicine

December 16, 2022 • Visual Feature

By Jeffrey A. Singer and Trevor Burrus

Join the Conversation

#CatoHealth

History doesn’t repeat itself.
But it often rhymes.

—Attributed to Mark Twain

Advertisement for "Dr. Pierce's family medicines," featuring an illustration of a family surrounded by various drugs and medicines from the turn of the century.

Today, opium prohibition seems almost natural, inevitable.

Yet opium and its derivatives were broadly legal in the United States before 1914. Americans could buy opium‐based products off the shelf.

Stock image of an old, blank piece of paper.

Advertisement for Dr. Seth Arnold's Cough Killer, which contained morphine, featuring a smiling little girl holding a small dog.

Advertisement for Brown's Iron Bitters (which contained cocaine) featuring a woman pouring a dose of Iron Bitters surrounded by three children.

Advertisement for Brown's Iron Bitters, which contained cocaine, featuring a young woman emerging from behind a pillar on which is written "Brown's Iron Bitters."

Doctors prescribed opium for many ailments because it often helped, especially compared with what else was available.

Illustration from 1880 of a doctor speaking to a well-dressed female patient.

An 1874 illustration of men smoking opium in an opium den in the East End of London.

During the first decades of the 20th century, the drug took on an increasingly negative image.

Consequently, the compulsive opioid user also took on that image, and addiction came to be regarded as a moral failing worthy of condemnation and criminal punishment.

Illustration of a typical drugstore of the 1880's, featuring walls lined with medicine behind counters.

President Richard Nixon sitting at a desk, replacing the pen after re-enacting the vetoing of a 1970 bill for photographers.

The Harrison Act was the first significant federal drug law in the United States and, as amended, was the basic federal drug law for 56 years until the Controlled Substances Act was passed in 1970. Drug War II began as government‐funded education/indoctrination campaigns started to instill a fear of opioids among doctors and patients alike.

Doctors feared that prescribing opioids might turn their patients into addicts. Even worse, doctors worried that prescribing opioids liberally might lead to their arrest and loss of their license to practice.

Reacting to multiple studies in the peer‐reviewed scientific literature along with admonitions from government health officials and medical specialty organizations, doctors and patients became less apprehensive about treating pain with opioids, and opioid prescribing increased considerably by the late 1990s.

Originally attracting the attention of federal regulatory agencies in 2006, this would soon be known as the opioid crisis — a surge in overdose deaths from the nonmedical use of prescription opioids and illicit drugs, particularly among adolescents and teens.

This formed the basis of the second, more massive wave of intrusion of federal and state power into…

…patient‐doctor confidentiality…

Professional organizations revised their pain management recommendations as the pendulum swung back toward opiophobia.

As in the 1920s, law enforcement and regulatory agencies are currently arresting or disciplining health care practitioners for engaging in what they determine to be “inappropriate” prescribing or “overprescribing,” when there is no consensus regarding appropriate prescribing in individual circumstances.

Patients and clinical situations vary and are often unique, and medical experts often have diverse views on their appropriate management.

Representation of agents waiting in a parking lot at dawn.

“It was a late winter morning before dawn, and I was looking forward to a trip with my wife (and clinic administrator) to see my daughter later that day. We decided for convenience sake to carpool to work. After we pulled into the parking lot and entered the building, I noticed out the side window of the building a blue sedan scooting into the rear employee parking lot. I told my wife that something strange was going on, so we went out the back entrance and to our horror there were at least 5 run‐down little dark colored sedans and then suddenly out popped a freak show.”

Continue Reading Dr. Stein's Account

“The first person I saw was a tall obese white woman with buzzed specked gray and black hair in police garb with the notorious ‘DEA’ printed on her armored vest. She was grinning an enormous ear to ear grin and joyfully proclaimed that she had a search warrant for the clinic and if I was Mr. Stein. Knowing full well that I was a physician, she barked, ‘Mr. Stein, I need to see your ID!’ I then went to the back seat of the car to retrieve the ID from a bag and was closely followed by a gangly guy with a handle‐bar mustache and sheriff’s badge. If it weren’t for the mustache, I would have sworn that it was the tall guy that played Midnight Cowboy. He was so close, almost on my back, that I thought he was going to spoon me right there. I asked him why he had to get so close and he said that he needed to see if I was going to pull out a gun. Instead, I pulled out my ID and then the grinning buzz cut goon shouted ‘Mr. Stein, this is a search warrant. Are there any guns on the premises?’ I responded by telling it that I would not talk to them and asked if I was under arrest and whether I was free to go.

Meanwhile, more federal agents scurried into the building. Most of them were pudgy little smurfs more at home tapping on a keyboard, not the [Efrem] Zimbalist Jr. types I remembered on tv. I went to call my staff and told them we wouldn’t be needing them that day, and then drove off to call my lawyers in relative privacy. Other agents with assault rifles filed in to secure the premises in front and back. They greeted patients as they entered the front parking lot proudly flashing their pricey rifles and pistols telling them that the clinic was closed and whether they would be willing to do an interview. In an apparently vain attempt to monitor the raiders, my wife stayed behind in the building. But it was of no avail; she was ordered by the black/gray buzz head to sit on a stool under guard or exit the building. That way the agents could plunder items not on the search warrant list such as clinic mortgage and financial documents and even a pistol stored in a safe. Nevertheless, my wife valiantly sat in that stool for nearly six hours, and by the time I returned to pick her up her, her face was drawn, flat and square; her eyes were red and welled up in tears. She had the expression of a rape victim. At the end of this surreal and horrible day I wondered why I ever went into medicine and especially why I was so foolish to select pain management as my specialty.

I have been running a pain management practice for more than 20 years. I trained in anesthesiology and pain medicine at well‐known schools. I have years of experience in advanced interventional techniques such as spinal cord stimulation, disc decompression. Our clinic uses physical therapy, injections, medical management including opioids and non‐opioids. We have a close relationship with a PhD with expertise in pain and psychology. For patients managed with opioids, we send out for urine drug testing in accordance with State guidelines, check the drug monitoring database, check the State court site and do pill counts. I don’t prescribe methadone and don’t prescribe benzodiazepines except a few pills before procedures. The vast majority of my patients have been on opioids and come from other practices or primary care physicians that do not want the hassle or risk involved with pain management. Opioid pain management is being thoroughly destroyed by the courts and government agencies. Opioidophobia has re‐emerged faster than you can say Salem witch trial. Seven million people have severe pain for which no good treatment other than opioids currently exists to help them. They are suffering enormously, and many are committing suicide. Practices are closing all over the country, opioid manufacturers are paying billions out in settlements to the government, and doctors deprived of income are stuck with incompetent public defenders. They are unfairly being portrayed by prosecutors and the media as drug dealing monsters in white coats with the predictable result being 20 years, 40 years and even life in prison.

Like many other physicians that treat chronic pain patients with opioids, I exist in a sort of limbo not knowing whether I will be able to practice or worse. Even though I haven’t been charged, my practice has suffered a decline of 25% after the local newspaper published the government’s unfounded and unsubstantiated accusations. Silly me for believing that due process and the presumption of innocence still exists in this country. Now pharmacists refuse to fill my prescriptions and tell patients that I’m a bad doctor and that they should find another doctor and go somewhere else. Many if not most colleagues have been supportive, but others avoid me as if I were a leper or treat me as a bête noire. I guess I won’t be able to visit my daughter any time soon because my lawyer has advised me to not to stray too far and remain in my ‘federal court district.’ Even my bank wants to me to come in for talk and answer a few questions. History teaches us that governments crave simple solutions for complex problems and scapegoats are always convenient devices. But what will the agents, prosecutors and judges do once their career ambitions and the public’s anti opioid fervor has been spent? How will they feel when some of them or their loved ones succumb to the same painful illnesses as those they have managed to oppress? And when will it end? Does it have to end when a DEA agent breaks his back and multiple surgeries only make things worse? Or a prosecutor develops a debilitating disease such as MS, rheumatoid arthritis, or neuropathy? Or a lawmaker’s mother goes through years of cancer with bone mets?”

“Upon taking [off] my coat and setting my purse down on my desk in the medical billing office, the supervising FBI women in charge took my cell phone and said they were going to scan it approximately at 6:10 AM. They had taken my keys from me and [I] was told to sit in [a] chair by my desk. At around 7:30 AM I asked to use the telephone to contact my attorney and was allowed to call out, but of course no one was open at this time. There was an OIG official who was in charge standing over me, and was going through my desk area at this time.”

Continue Reading Sharon Stein's Account

“I asked to use [the] phone around 8:30 AM and was allowed to call [my] attorney at Pine Bach. I reached the secretary who had to take [a] message. After I hung up, I asked the OIG agent if [it was] possible to move to [the] front desk area as [a] phone call was supposed to come in from [my] attorney. He stated, ‘You made your phone calls and now you’re asking too much.’ I stated, ‘You took my cell phone as well,’ and asked for it back, and he said ‘You’ll get it back when the agents are done with it.’ He stated to me, ‘You’re becoming a problem and need to sit here or [you] can leave.’ About ten minutes later, the FBI women in charge went by and I asked her to please check if [they were] done with my cell so I could get it back. I was instructed upon sitting in my chair to not touch or move, and when I asked to go to the bathroom I was escorted there as well by [an] FBI female.

I was asked by the DEA and the Sheriff and FBI agents to try and unlock the safe in my office and Dr. Stein’s gun safe. [I] went to the office escorted and was not able to open [them], and told them to remove [the safes] and take with [them] upon no success.

I was walked back to [my] office and moved to the front office around 10:45 AM when my cell phone was given back and Dr. Stein phoned to tell me Attorney Brian Fahl was on [his] way. Around this time, [the] attorney phoned back from Pine Bach and the OIG agent who was standing over me allowed me to answer the phone. The OIG agent was 5’11”, around 215 pounds, white male, around late 50s and [with a] balding hair line.”

“She was grinning an enormous ear-to-ear grin and joyfully proclaimed that she had a search warrant for the clinic and [asked] if I was Mr. Stein. Knowing full well that I was a physician, she barked, ‘Mr. Stein, I need to see your ID!’ ”

“Other agents with assault rifles filed in to secure the premises in front and back. They greeted patients as they entered the front parking lot, proudly flashing their pricey rifles and pistols, telling them that the clinic was closed and [asking] whether they would be willing to do an interview.”

“The vast majority of my patients have been on opioids and come from other practices or primary care physicians that do not want the hassle or risk involved with pain management.”

“Even though I haven’t been charged, my practice has suffered a decline of 25% after the local newspaper published the government’s unfounded and unsubstantiated accusations.”

“Like many other physicians that treat chronic pain patients with opioids,
I exist in a sort of limbo not knowing whether I will be able to practice, or worse.”

Mark Ibsen, MD
Helena, MT

Todd Hess, MD
Minneapolis, MN

Jay Joshi, MD
Munster, IN

“We know opioids do work when properly completed and placed, and monitored. The clinic has proven that. But it became very difficult as pain specialists to do our job with the
constant threat of board reviews, attorney general reviews, DEA, FBI, and insurance decredentialing.”

Todd Hess, MD

And when doctors are targeted, patients suffer.

Here are the real stories of pain patients who have been directly impacted by government mismanagment of the opioid crisis.

“No one knows, nor understands the difficulties in every day life when you are constantly suffering except those in this pain and their loved ones impacted because we, the chronic pain sufferers cannot function without the relief of opioids.

We are not addicts, we are not using the medications to achieve a ‘high.’ We are not selling our medications. We use them as they are prescribed to help us participate in our lives and in the lives of our families.

Please stop labeling us and start helping us by alleviating the pressure on our Doctors that took an oath, ‘to do no harm.’ We’ve been persecuted enough with the system that tells the world we are on pain medications. We are forced into pain management, if we are fortunate enough to find a practice that can accept us. […]

Jamie Freeman, RN
Atlanta, GA

“I have been in pain management for 17 years, following every rule they have. Been cut 70% on medications that enabled me to do part of what a wife and mother entail. Now, if I buy groceries, I spend the next day in bed, can not exercise, stand for more than 30 minutes, all due to disc disease, autoimmune diseases, immune deficiency which makes treating autoimmune properly impossible.

My pain physician says I meet all criteria for opiod [sic] prescribing, but his hands are tied in regards to the 90mg MME guide set by the CDC. Recently several clinics in our area were closed because those doctors believed that pain management did not fall under the umbrella of the new guidelines which has been stated, written but evidently not okay.

Someone please clear up this poorly designed law, otherwise animals receive more humane treatment than human beings.

Quantity of life means nothing when quality is absent/unobtainable.”

Sharon McKenney
Colleyville, TX

“On October 26, one day after his 23rd birthday, my youngest son took his own life after a horrific 3 year battle with CRPS. We had tried many things, none of which worked. He was on his 3rd pain doctor and was fairly stable on 2 different opioid medications among other things. His pain dr abruptly left the practice for reasons we don’t know. After one visit with the new dr that took over, he received a letter that dismissed him immediately from the practice. It said they would treat him on an emergency basis for 30 days while he found another dr. Due to insurance issues we went past the 30 days before we could get him scheduled for another appt. His dr wouldn’t prescribe even one more month of his opioids even though we had an appt scheduled with his new dr. Because of this my son was suddenly without his meds for a week.

The pain was more than he could bear, and he ended his unimaginable pain by taking his life. […] Now my family will have to go on without my precious son who was a gift to this world and had so much potential.”

Julie Wilburn Stephens
Irving, TX

“I am a 47 year old CPA, employed full time who was in a major car accident at 13. I have pelvic shear fracture that healed crooked and with a twist (a vertical and horizontal inequity in my pelvis), and an acetabular hip fracture. I have suffered from chronic back hip and other pain (shoulder pain due to use of crutches and cane long term) since the age of 22 and have struggled to maintain a productive life since the war on pain medication. I have had multiple hip surgeries due to osteoarthritis from the acetabular fracture first and then due to instability in the hip due to painful subluxing and subsequent dislocations.

[…] Without my medication which has been severely cut and has hindered my quality of life considerably I would not be able to work or be productive in any way.”

Rachael Bowman
Saint Charles, IL

“I think anyone faced with the amount of pain we deal with has suicidal ideations from time to time. I finally have my full dx for cancer: stage 4 metestatic breast cancer, in left breast, left rib under my collarbone, sternum, lumbar spine, right iliac, and right femur. Not fun. My regular doctor and palliative care doctor are now fighting with the insurance company to increase my pain meds back to what they were up until February 2018, with the addition of breakthrough pain meds. […] Cancer pain is supposed to be exempt from the guidelines — cancer pain plus what I already had before *should* get me well above what we’re asking for without a problem, not an argument from someone at the insurance company with a list! I will keep fighting, but as the cancer progresses later on (as the meds to control it don’t tend to work forever), I’ll need higher doses. […]

I will try my best, but I can only do just so much. All of us together though makes it harder to be ignored. Be loud! Hopefully our pleas won’t fall on deaf ears for too much longer.”

Audrey Lynn

“In 2018 I attempted to kill myself due to enduring excruciating pain for 18 months. I had a plan in place for over a year. If I was unable to get relief from the constant torture, I saw no reason to continue my life. After a visit with my Pain Mgt doctor, I was told by the pharmacy that I would have to wait 3 days to pick up my written Rx for pain meds. This was a week prior to yet another surgery on my spine. I was scheduled to have a lumbar fusion to correct the damage left by a surgery 6 months earlier. My surgeon’s nurse told me that I was now an addict and they could not assure adequate pain relief after this operation. Since I did not want my death counted as an Opioid overdose which would harm my fellow chronic pain patients, I took a handful of Ambien, got in a hot bath with a knife and a bottle of Vodka. The knife was not sharp enough to cut the veins in my wrist. […]

The misapplication of the 2016 CDC Opioid Guidelines have not stopped the overdoses of Heroin and Illicit Fentanyl, the true sources of the opioid crisis. They have resulted in damaging the lives of chronic pain patients and their families. […]

Our lives are in peril due to the effects on our bodies from chronic unrelieved pain.”

Celia Sexton
Louisville, KY

“I was taken off opioids cold turkey by a quack of a pain management doctor, in August, 2019. There ensued one month of pure hell, exacerbated by a case of flu, and pain at levels I could barely tolerate. I hardly remember that month. I saw a cardiologist for the first time yesterday for ever escalating blood pressure, and woohoo, I’ve had a silent heart attack in recent history. I know! I know! It was when I was tossed into withdrawal to protect that anesthesiologist’s huge pill mill. I am mad, I am furious.

Chronic pain patients are left to suffer with limited motion and quality of life, while we protect those morons who abuse opioids until they die. I imagine, like prohibition, this will resolve itself. Will I live to see it?”

Betty K. Moore

“It’s about time! My dear wife recently underwent Hip Replacement Surgery. Due to a poor job by her Orthopedic Surgeon, she had some very painful problems, which, in concert with her PCP, caused her to have to take more of the Opiod [sic] medication, than what was written on the Script directions. Her PCP wrote another Script to manage her pain. He specified in the directions, that he was authorizing an early refill. When I went to Walgreens to pick up the medication, the pharmacist refused to fill it early, citing the ‘laws’ handed down by the CDC. Though it was obvious that the Doctor was fully aware, and indeed authorized the early release, this pinhead of a pharmacist took it upon herself to countermand the doctors directions. She said Walgreens could be sued if she filled the Script. So my wife was left to cry out in pain for four days, until the original 30 days had elapsed. There was no empathy or common sense used, whatsoever.

This type of idiocy must stop. I know this is not what the CDC intended by implementing their guidelines, but without clarification, this type of travesty will continue.”

Lloyd

“My husband found me in bed and unresponsive where I had been all day. After calling 911 he did chest compression until EMS arrived. Most of the next several days where in a haze. But what I’ve been able to figure out is that they treated me for an overdose that I didn’t have. They did a UA and found opiates in my systems because I wear a medicine pump. But the part that’s [even] worse [is] that they told me I tested positive for methamphetamines which is something I don’t use. This is what I have been able to surmise thus far. I take both Wellbutrin and Trazodone for depression. According to GoodRx both can give a false positive for methamphetamines. And my psychiatrist sent me a study that shows that Wellbutrin can give a false positive for methamphetamine.

Since they didn’t try to do a drug test with blood or even do further testing they continued pouring drugs into [me] to treat a fictous [sic] overdose of opiates. […] Obviously what they were doing wasn’t helping any so they finally decided to stop all meds. And this is what it took to get me back.

I feel literally abused by these doctors who refused to believe that I had a false positive result.”

Kathleen Kaiser
Wichita, KS

“Diagnosed with Degenerative Disc Disease in April 1990 (at 26 yrs old, born July 1963) via on the job injury which forced me out of my career as a tennis teaching professional. Was informed that I’d be on pain management meds the rest of my life as the condition worsens over time being degenerative and nothing can be done. […]

I have a perfect 25+ year history of taking my meds responsibly never once failing a drug test, losing a Rx or any pills. […] Now with forced tapers, I suppose being cut by 50% I’m considered among the “lucky” as at least I’m still receiving some meds, but not effective as far as addressing my level of pain which continues increasing over time. […]

Please do the right thing and restore ethics and compassion, and allow doctors to provide very necessary and adequate Rx guidelines on a case-by-case review basis.

This has been nothing short of slow, painful systematic torture which even the WHO has said is both a form of physical and mental abuse, which I am in full agreement with.”

Rob Rubin
Pleasanton, CA

The treatment and management of acute and chronic pain involves the same nuanced medical decisionmaking as does the treatment of hypertension, diabetes, infectious diseases, and psychiatric disorders.

There is no justification for law enforcement personnel, untrained in the health sciences, to intervene in a matter for which health professional licensing boards were created.

nor the act of self‐medication