National Opioid Settlement Injunction

THERE IS A NEW LEGAL DOCUMENT that:

• Was created without public input, but has negatively impacted the essential care received by millions of patients across our nation?
• Has a secret component that has fractured critical pharmacy operations and prevented patients from receiving legitimate prescribed medications?
• Generates data “for the benefit of the DEA” and the State Attorneys General to single out physicians who may have done nothing more than attempting to help patients being hurt by this very document?
• Like a corrupt monopoly, created layers upon layers of bureaucracy which are made impenetrable to breach?
• Puts this machinery in place to fight the alleged harm being created by prescription pain medication, a false narrative based on false data?

How does this fifty-four-page document up-end a critical part of our health care system with almost no one knowing? The following revelations should set everyone on the path to immediate action!

WHO AND WHAT WAS INVOLVED?

In July of 2022, the National Association of Attorneys General announced that they had negotiated a settlement with the three main distributors/wholesalers of controlled substances: AmerisourceBergen, Cardinal Health, and McKesson. The settlement was signed by 41 of the 50 states. The monetary part of this settlement is not the critical component; the damage to our healthcare system is being done by the Injunction.

HOW DOES THE INJUNCTION ACHIEVE A STRANGLEHOLD ON BOTH PHARMACIES AND PHYSICIANS?

• It creates “SECRET THRESHOLDS” for pharmacies.
  • this legal direction results in catastrophic confusion for both pharmacies and their customers as neither can be informed how much of a pain medication, they are receiving every month. Patients often cannot find a pharmacy that has their medication in stock. (Note: These Threshold limits are applied in addition to the DEA yearly cut in production quotas)

• It requires the Distributors to rain terror on its pharmacies:
  • the Distributors must decide what is a “suspicious order,” and then if identified, they must halt that order from being delivered. (see “Definitions Addendum” for “red flags” and “suspicious orders.”)
  • based on the interpretation by the Distributor, it can stop ALL ORDERS of controlled substances to that pharmacy, often putting it out of business.
  • Distributors are now required to report both “suspicious orders” and all “red flags” not just to the DEA, but to the state’s Attorney General.

• It adds layers of bureaucracy to enable data mining for the DEA. It does this through a new position called a Monitor, as well as a Clearinghouse and Clearinghouse Advisory Panel. This new hierarchy:
  • creates customized reports to search for “suspicious physicians.”
  • specifically recognizes the DEA as a central “stakeholder,” and creates reports for DEA’s “benefit.”
  • acknowledges reports are “incomplete” due to the nine states not being party to the settlement, and yet continues to use this data punitively.
  • has, for their obvious benefit, written a clause stating that none of the above entities are liable for data breaches and data integrity, including immunity from consequences to individuals for incomplete data.

WHAT HAS BEEN THE IMPACT ON PHARMACISTS AND PHYSICIANS?

• Pharmacists are increasingly feeling pressured to deny prescriptions for fear of having themselves or their pharmacy scrutinized and unfairly persecuted.
• Some pharmacists have stated that the new requirements are causing increased stress and worry that, because of this added workload, dispensing errors will increase.
• Physicians who are now aware that any prescription they write might end up on their Attorney General’s desk, or that data mining may mark them as a “suspicious physician,” are increasingly making the choice to stop prescribing controlled substances altogether.
• Physicians, often mandated by their employer, have forced taper patients whom they think might put them in the cross hairs of these new requirements.
• Physician morale is dropping as they see their “physician-patient relationship” dramatically eroded.

WHAT HAS THE IMPACT BEEN ON PATIENTS?

• Patients with legitimate prescriptions are unable to obtain critical medications from their pharmacy with predictable consequences:
  • being forced, with risk of being accused of “pharmacy shopping,” to reach out to multiple pharmacies to locate their medication in stock.
  • waiting for their physician to resend the prescription, a requirement that adds to the gauntlet the patient must endure.

• Patients are losing their quality of life. This is true, not just for the millions of chronic pain patients, but for patients in acute pain, and those receiving behavioral health medications which fall into the category of controlled substances. Patients who are forced to live with uncontrolled pain or a severe mental health disorder:
  • lose their ability to function and are suddenly unable to care for themselves, or as a caregiver, they can no longer provide this critical assistance to family members.
  • are physically and emotionally no longer able to manage physician appointments and become “lost to follow up.” This causes loss of preventative health screening and raises the burden of preventable conditions, such as hypertension and diabetes, on our health care system.
  • patients have opted not to have needed surgery as they are being told they will only get Tylenol or an extremely short post-operative time with adequate pain medications.
  • patients who were working are now unable to work, or must cut back their hours.
• Most concerning of all, there are patients who lose access to their medications to such a degree that they find themselves in unrelenting pain. A growing number of these patients end up taking their own lives.

CONCLUSION:

With this settlement, the State Attorneys General have decided to ignore every piece of evidence available that clearly shows prescription medications are not, and were never, the cause of the “opioid crisis.” This injunction shows, beyond any question, that they are determined to plow forward on a false narrative. It makes no difference to the Attorneys General, that there are innocent people harmed or dying in the process. Physicians, pharmacists, and patients are just collateral damage.

It is imperative to ask ourselves who gets to determine the quality of life of millions of patients in pain. The State Attorneys General must be held accountable for the catastrophe they have created.