PAINKILLER LAW BLOG: Fear, Dread and a Warm Welcome – Here Comes Zohydro

How can a drug about to hit the market be feared, dreaded, welcomed and deemed medically necessary, all at the same time? It’s complicated, so if the new “super painkiller” Zohydro had human feelings, it would definitely be in the midst of an identity crisis. In this post I’ll talk about the Zohydro kerfuffle, and why it’s more proof that in most cases, “blame” for prescription drug addiction lies with the drugs themselves, not the doctors who’ve prescribed them.

First, what is a “kerfuffle?” It’s a brouhaha. Commotion. Turmoil. Uproar. Hubbub. I learned the word from The Onion. Second, why the kerfuffle over Zohydro? Because Zohydro, a new opioid painkiller approved by the FDA and slated for market entry soon, is ten times more powerful than Oxycontin or Vicodin, and it contains no abuse-deterrent formulations. This has policymakers and even some medical societies worried that the drug will – well, how to say it gently? – kill or injure a lot of people who will be using it. Though the drug is slated to be used as a painkiller of last resort for patients who cannot get relief from other medication, its potency and its emergence on the market in an era of high rates of addiction, overdose and death from opioid painkillers are indeed cause for concern.

Last year, an FDA panel opposed approving Zohydro; the FDA itself then went against its panel’s recommendation and green-lighted the drug. The drug’s approval has been the subject of controversy ever since, and this week U.S. Senator Charles Schumer (D – N.Y.) asked the Dept. of Health and Human Services to reverse the FDA’s decision. Good luck, Chuck; the Congressmen from Big Pharma likely have a different view.

The controversy swirling around Zohydro got me thinking about doctors who prescribe opioid painkillers, and of law enforcement efforts to “do something” about the prescription drug crisis. To me, at the core of the Zohydro debate is the widespread belief that the drug’s mere availability will further aggravate an already serious public health problem. Is the worry that doctors, however cautiously, may be prescribing it? Or is it that Zohydro will exist at all? My answer is that people are worried about Zohydro’s very existence. To date, media reports haven’t much discussed the role doctors may play in prescribing the drug; reports instead have focused on how Zohydro’s very presence in the market will automatically impact the prescription drug crisis.

Isn’t this a powerful indicator that the problem could be the drug itself? After all, doctors would be directed to follow protocols, guidelines, safety measures and other steps in assessing patients’ eligibility and need for the drug, its effectiveness, and any problems that might arise in treatment. If that part of the discussion is so irrelevant in the minds of Zohydro critics, then doesn’t it stand to reason that doctors ordinarily aren’t the problem? Yes, it does, in case you’re on the fence about that one. I have long believed that in all but the extraordinary, outlier case, prescribers aren’t the problem so much as the drugs they’re prescribing are. The Zohydro kerfuffle is but one more piece of evidence that aggressively targeting legitimate doctors is the wrong way to go, especially when the same law enforcement agents who self-righteously kick in office doors and hold slanderous press conferences refuse to look past their own noses for the real roots of the problem.

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Comedian Chris Rock has a great bit about why we should all be vigilant for evidence of prejudice or bigotry. As he puts it, when illegal aliens are targeted, “I start listening, because I know blacks and Jews are next.” Then he looks at his watch and adds, “That train’s never late!” This lesson of vigilance is extra important today for all medical providers who prescribe opioids for chronic pain.

For months now, law enforcement has been leading the charge against so-called corrupt doctors and others who prescribe what are viewed as excessive amounts of opioids. In my view, as you know from previous PAINKILLER LAW blog posts, law enforcement’s leadership in this area amounts to putting the cart before the horse: Cops should not be telling doctors how to treat patients. But very recently there has been a slew of crucial developments that sends an unmistakable signal to prescribers, to the risk managers who help insure them, and to the malpractice defense attorneys who defend them. Attention must be paid, or prescribers will get in trouble, risk managers will write a lot more checks, and malpractice attorneys will not prevail using old arguments. And, of course, patients could be unsafe.

To have your ear to the train tracks on this issue is to know that now the scientific evidence is starting to match law enforcement thinking. This means a provider who does not keep up with scientific advances, and information provided by a source other than the pharmaceutical industry, risks getting run over by the oncoming locomotive of opioid reform.

Consider developments from just the past two weeks:

-The Centers for Disease Control’s director declares that too many doctors are prescribing too many opioids for too many people, with deadly impact and little patient improvement.

-The American Medical Association’s new recommendations on opioid prescribing acknowledge the CDC’s position and urge a significant shift in direction by opioid prescribers.

-A Harvard Medical School study finds it inconclusive that opioids are effective in the treatment of chronic pain.

These statements and studies have profound implications: If you as an opioid prescriber practiced in a way that even six months ago was roughly in compliance with the state of scientific knowledge, it would be harder to pin a crime on you if something went terribly wrong with a patient. But now, in the face of evidence from leading scientific and medical authorities which up-ends previous thinking about opioids for chronic pain, a practitioner who doesn’t adjust and adapt and possibly wholesale reform his or her methods of practice is putting themselves on a perilous path. It’s time for opioid prescribers nationwide to shift their practice methods to reflect and incorporate the CDC’s and AMA’s statement and recommendations. To ignore the advancing science is to invite law enforcement scrutiny, and deny yourself the chance to say, “As soon as the science changed, so did I.” Don’t get hit by an oncoming train. MEISTER LAW OFFICES 213.293.3737

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Do you know of a medical provider who has been summarily and without recourse dropped from a retail pharmacy‘s list of approved prescribers? I do. I know a lot of legitimate, caring professionals who are in this predicament, and know of many more nationwide feeling the unjust squeeze of tremendous, invisible power. Retail pharmacies, both independent and chain stores – let’s call them “Little Pharma” – are so scared of the DEA that they’re cutting off MD’s, DO’s, and PA’s without notice, without any specifics, and without any means of redress, all in a desperate attempt to try and keep the Feds off their backs. There’s a new blacklist in town, and it’s yet another kneejerk, excessive and unfair response to the problem of prescription drug abuse.

Typically, a medical provider gets a letter out of the blue and that…is…that. The pharmacy or its corporate attorney tells the provider that the pharmacy’s responsibility is patient safety first, and that it is obligated under federal and state law to make sure it doesn’t dispense scrips written by “problem” prescribers. But no details are offered, no specific instances of conduct or prescribing are cited, and no basis for the pharmacy’s decision, other than vague references to statutory language, is provided. You as a medical provider have been branded a problem. You don’t need to have been red-flagged, you don’t need to be under investigation, and you can’t do anything about it unless you decide to go public. Or you can sue, if you feel like devoting the next several years and all of your financial resources to fighting a major corporation, its mountains of money and its legions of lawyers.

On the surface, the pharmacy or its corporate counsel is in charge. But beneath the surface is where the true power is being invisibly, silently exercised. It’s beyond the reach of the legal process; it’s immune to the presumption of innocence, and it’s happening to people we know. Pharmacies are either being leaned on by federal agents to nix a certain provider from the pharmacy’s approved prescriber list, or the pharmacies are afraid of attracting attention by continuing to fill a provider’s scrips if, say, the provider is in the news in a less than flattering way. Fear quickly prevails: Years-long business relationships and friendships evaporate in the time it takes to generate a form letter; patients are needlessly harassed and embarrassed at pharmacy counters, and all the while, no one will say why. This is something out of McCarthyism; it’s something out of Franz Kafka. It’s government overreach is what it is, and it’s real.

What to do about it? I say stand up and fight back. We are, after all, Americans. The idea of government thinking it can push law-abiding citizens around is so at odds with everything in our national DNA, that eventually public objections will build sufficiently and law enforcement agencies will either voluntarily or under judicial compulsion have to take a giant chill pill. Let’s just hope that when that day comes, the pharmacy can still dispense to the government agent in need of a step back.

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Recently I attended a conference sponsored by the California Medical Board and Board of Pharmacy. I think I was the only criminal defense lawyer in the room. The two-day event was entitled, “Joint Forum to Promote Appropriate Prescribing and Dispensing,” and was supposed to help healthcare providers and pharmacists know the law of controlled substance prescriptions, so they could follow the law and care for patients better. But that didn’t happen. Instead, during a Q and A with high-ranking Board officials on a panel, one attendee put it perfectly: The Boards are in “punitive” mode, “waiting to pounce” on prescribers and providers. That really was the unmistakable and highly regrettable message of the conference. In this post and several to follow, I’ll explain.

The voice of reason was heard briefly in the conference’s opening session. It belonged to the White House Office of National Drug Control Policy, better known as the Drug Czar. The speaker from the Office listed ways to screen for potential abuse, advice for effective patient monitoring, relevant CME, and other tools doctors could use in caring for patients while helping to curb abuse.

The speaker’s final suggestion was the most interesting, to me: He advised providers to regularly prescribe naloxone, the “anti-overdose” drug that has helped save the lives of accidental opiate overdose patients around the country. Great idea! But there’s also a downside, which I pointed out to the speaker: In today’s aggressive enforcement environment, the DEA and Medical Board might view writing for naloxone as prima facie evidence of excessive opioid prescribing. After all, if a doctor felt a patient was at risk of overdosing, why did the doctor write the opioid scrip at all? And why did a pharmacist fill it? What I fear, and what the official acknowledged could be a real issue, is that a provider’s or pharmacist’s act of patient protection could be used against them in a federal or state criminal investigation. That, to put it technically, would be totally uncool. And unfair. And inadvisable as policy and practice.

When the Drug Czar’s office had concluded its remarks, the DEA assumed the microphone. With that transition, the voice of reason gave way to a one-sided call to arms against the very professions represented by the conference’s attendees. More on this in the next post. MEISTER LAW OFFICES 213.293.3737

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PAINKILLER LAW: FDA and I Call For Abuse-Deterrent Drug Agents

The FDA today called upon pharmaceutical researchers to develop formulations of opioids that would bring pain relief while reducing the possibility of addiction. The FDA refers to “abuse-deterrent” drug agents in the chemical sense. I join the FDA in calling for abuse-deterrent drug agents, only the kind of agents I’m talking about wear badges, drive fast in unmarked cars, and show up heavily armed.

The FDA should be commended for its balanced approach, in which it seeks both the development of less addictive drugs, and the need to get real pain relief to patients. What concerns me is that in investigating healthcare providers who write Schedule II-V prescriptions, typically law enforcement agents including the DEA and state Medical Boards emphasize “case clearing” over balance, hard and fast over nuance, and black and white over shades of gray. Whereas the FDA’s January 9 statement expresses its extreme concern “about the inappropriate use of prescription opioids,” the FDA doesn’t define “inappropriate.” Left to the determination of the DEA, which has been accused of being late to the party on addressing prescription drug abuse, and left to state Medical Boards, which have been accused of bailing on the party altogether, the definition of “inappropriate” could be bent, twisted, contorted, and most dangerously, broadened to encompass practices and procedures which a better informed or more detached observer would never contemplate. But when the warrant is signed or the cuffs slapped on, it’s too late for a healthcare provider to say, “Let’s slow down, back up, look at this from the beginning, and then discuss.”

That is why every healthcare provider, risk manager, medical group manager and professional needs to know the black-letter federal and state law of Schedule II-V prescriptions, and the nuances and subtleties of how the law is interpreted, what influences and impacts the agencies charged with “cracking down” on supposedly corrupt providers, and what you can do now, today, to ensure patient safety and the protection of your practice. This is why PAINKILLER LAW exists. Don’t let yourself fall victim to the subjective and loosey-goosey way law enforcement agencies and Medical Boards are defining “inappropriate,” “overprescribing,” “gross negligence,” or other concepts whose interpretation could be fraught with peril for even the most honest and ethical MD, osteopath, or physician’s assistant. Let us help you verify, achieve and maintain full compliance with the laws that well-intentioned but hopelessly biased drug agents are ever more aggressively attempting to enforce.

PAINKILLER LAW – It’s good preventative medicine. 213.293.3737 MEISTER LAW OFFICES

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“The Warm Blanket” is how many opioid users describe the feeling of being under the drugs’ influence.  Orally or injected, and regardless of the reason(s) the drugs may be taken, this description has been documented across the user spectrum.  PAINKILLER LAW’s position on prescription drug abuse is that even if a patient or an addicted person – or an addicted patient – needs the warm blanket, that does not necessarily mean criminal or civil liability should rest with a prescribing healthcare provider.  In other words, in all but the most extreme cases, the blanket is warm, but the trail back to the ultimate question of “why?” is appropriately cold.

And speaking of “cold,” I don’t mean to sound cold or heartless saying that.  Grieving parents of deceased addicted children need comfort, not a lecture.  None the less, it is true that healthcare providers are generally NOT to blame for prescription drug abuse.  Here’s an example:

This past Thanksgiving Day in Minneapolis, two teens broke into a man’s home to steal prescription medication.  They weren’t looking for iPads or a flatscreen TV or even cash; they wanted pills.  The homeowner shot both teens dead.  For reasons not yet fully disclosed by police, he’s being charged with murder.  But my focus is the teen burglars.

Let’s assume the teens were addicted to prescription pills, let’s say opioids.  They committed the crime to feed their habit one way or another, either by planning to ingest the drugs themselves, or by selling them to buy other drugs for personal use.  Let’s further assume that the teens were first prescribed opioids by a legitimate healthcare provider.  They became addicted over time; to not feed the habit now would bring on the days-long agony of withdrawal.

Who is liable for the burglary?  The teens; they did it.  Who, if anyone, is liable for the act of killing them?  The homeowner, if he can’t claim self-defense, which you’d expect he’d be able to do.  But if the homeowner is charged, can he defend himself by blaming the doctor who prescribed the opiates to the teens?  Is there a causative link between the prescriptions, and addiction-fueled criminal behavior, sufficient to excuse the homeowner from killing them?  Should the healthcare provider be sued by the teens’ parents for wrongful death at the hands of the homeowner?  Should the healthcare provider’s act of prescribing be criminalized, independent of the burglary or murder case?  Should the very act of having written scrips for these teens end up with a doctor, or osteopath, or physician’s assistant, or nurse practitioner, stripped of their license and doing hard time?  Would a healthcare provider still be liable if the teens had not committed a crime?

There are already some states, like Florida, which criminalize “overprescription,” if anyone can define it, and I’d challenge you to come up with a durable, scientific and constitutional definition.  Then there’s my state, California, whose law conveniently doesn’t define “overprescribing” but whose law enforcement agencies still try and charge it.  And there’s a national law enforcement drumbeat to “do something” about prescription drug abuse by targeting legitimate healthcare providers writing reasonable prescriptions for approved drugs.

What are your answers to the questions above?  My answer to all of them is an emphatic “no.”  And even if reasonable people can disagree, that only means the issues are too complicated for law enforcement agencies to handle prescription drug abuse as though this were a straightforward issue with an easy remedy.  As the old saying goes, “For every complex problem, there’s a simple solution, and it’s wrong.”

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PAINKILLER LAW: Fear and Self-Loathing in the Medical Academy

A recent article by Drs. Zachary Meisel and Jeanmarie Perrone, who teach at the University of Pennsylvania Medical School, asks whether “conscientious and well trained” doctors are to blame for prescription drug abuse. The authors say “yes.” That is, they say doctors are partially to blame, but the authors stay silent on why anyone else might be. That silence is damning, the good professors’ assessment is wrong, and their article is of great concern.

Not only is Rx abuse far too complex a problem to “blame” on any one constituency, but even more critically, it is always unsettling and even scary when one or two members of a profession presume to apologize on behalf of their colleagues nationwide for some perceived wrong. Today across the country we are seeing what the White House Drug Czar has called an “epidemic” of Rx abuse. We are also in response seeing a misplaced, hamfisted law enforcement approach to what is, in all but the most extreme cases, a public health problem. Federal and state law enforcement agencies will only be emboldened by an article whose glittering generalities
help legitimize the illegitimate and ill-advised belief that routinely going after doctors for alleged criminal conduct is the solution.

So are doctors to blame? In PAINKILLER LAW’s view, no, except in the most extreme cases. If a healthcare provider screens a patient carefully, does a thorough exam and makes an informed diagnosis, prescribes within the boundaries of established safety for an approved drug, counsels the patient on the possibility of addiction, monitors the patient conscientiously, verifies with any available prescription drug database, and uses his or her best judgment about how the patient is doing, what is the basis for a criminal charge against that doctor in the event of addiction or an overdose? Can the authors enlighten us, please, before asserting that good doctors are partly to blame?

Who else might be to “blame?” Patients themselves? That notion borders on blasphemy within the White House Drug Czar‘s Office; don’t be “blaming the victim,” the reasoning goes. What about Big Pharma? The drug companies marketed the pain-relieving powers of Oxy and its many opioid cousins back in the late 1980′s and early 1990′s. Were they wrong about the pain-relief qualities of the medications? Did they purposely understate the potentially addictive qualities of the drugs? What about medical schools and the philosophical and educational change that took place around the same time, so that med students would be trained to acknowledge and treat severe pain? Should we indict your school’s Academic Senate?

The point is, it’s too easy, suspiciously easy, to blame doctors, and that’s precisely what should make folks like Professors Meisel and Perrone think twice and choose their words carefully before they effectively if inadvertently bless today’s ill-conceived law enforcement priorities. Because if they’ve ever written a pain scrip themselves, they may have just made what an excitable cop or prosecutor might call a confession.


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This past Sunday, the LA Times ran a searing and exhaustively researched article on prescription drug abuse, called “Dying for Relief.” This past Monday, as is the fashion among legislators nationwide, a California lawmaker loudly reacted to the article and grabbed a headline of his own.

Ordinarily, a legislator’s jumping on the bandwagon after a big article runs in the paper isn’t news. But here it is, because in response to the national public health problem of prescription drug abuse, California State Senator Curren Price, Jr. is introducing legislation that targets healthcare providers for law enforcement action. A law enforcement approach to a public health problem typically scores political points and funds new multiagency task forces, while doing nothing to actually address the problem. And innocent people – here, legitimate healthcare providers writing legal prescriptions for approved drugs – get steamrolled in the name of public safety.

Price’s idea isn’t so outrageous: He wants coroner’s offices in California to automatically report patient deaths to the California Medical Board whenever a coroner concludes that prescription drugs caused or contributed to someone’s death.

But the devil will be in the details, because the Medical Board is under tremendous pressure to “crack down” or “do something” about Rx abuse and suspected corrupt healthcare providers. All this while California law doesn’t even define “overprescribing,” for example.

PAINKILLER LAW will be watching very closely for the language and implications of the Price bill. I’m concerned that whereas a coroner’s findings may be circumspect and sober, the Medical Board will eagerly grab the autopsy report and form a posse to go after the “bad guy.” Senator Price needs to be alert to the pressure the Board will put on him and his committee to give the Board too much latitude in investigating, accusing or proceeding against healthcare providers who’ve written prescriptions for potentially addictive drugs. The offense itself is not clearly defined, yet law enforcement will want broad discretion to target it. That’s putting the cart before the horse.

Contact PAINKILLER LAW: CRIMINAL LAW COMPLIANCE FOR HEALTHCARE PROVIDERS, for a free consultation. We want to help you verify, achieve and maintain compliance with the criminal laws of prescribing for Schedule II through V drugs.

213.293.3737 Meister Law Offices

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NEWS ITEM: According to physician and medical staff recruiting firms, the most sought after healthcare providers are internists, family practitioners, hospitalists, nurse practitioners and physician’s assistants. The healthcare sector continues to grow, the population is aging, and people need and deserve quality primary care.

NEWS ITEM: According to the AMA, many patients in dire need of prescription pain medication can’t get their meds, because of D.E.A. production and distribution quotas and resulting pharmacy shortages.

NEWS ITEM: A Los Angeles area osteopath is being prosecuted for multiple counts of murder, following the overdose deaths of three pain Rx-addicted patients.

If you are a healthcare provider, what should your takeaway be from this news trifecta? I’d say (a) primary care is solid work; (b) pain patients are going to call you at midnight before a holiday weekend to ask for an early refill, which their pharmacy may or may not give them, but you’ll still get the call; and (c) if you dare step outside whatever the DEA says the current line is, you’ll wax nostalgic for your bygone days as a medical resident when sleep deprivation and verbal abuse were the worst of your worries.

If you are a patient, what is your takeaway? That people around the country, who you don’t know, are addicted to pain medication in significant enough numbers that policymakers in Washington, who you you wouldn’t want to know, are telling your healthcare provider’s nurse, who you just met last week, that your pharmacist who you’ve known for years can’t dispense the medication you need in the quantity or dose required because your doctor, who you’ve known since you met her at your wife’s niece’s Bat Mitzvah three years ago, doesn’t know her practice as well as a bunch of narco agents. Frustrated? Take a pill – wait, I’m sorry. You can’t have one.

If you are law enforcement, what is your takeaway? That come hell or high water, the “crack down” on prescription drug abuse will continue, whether it deprives patients in need of medication because of production or distribution quotas, whether it fails to meaningfully and continually instruct healthcare providers in what to do now, instead of playing “gotcha” later over some purported failure or lapse, and whether you’re even defining what it is you’re pursuing, before you set off in pursuit of it.

Until the federal government stops treating a public health problem as a law enforcement problem – I don’t expect this to happen any time soon – there’s PAINKILLER LAW: CRIMINAL LAW COMPLIANCE FOR HEALTHCARE PROVIDERS. There’s healthcare compliance, there’s HIPAA compliance, there’s compliance for every aspect of every practice – except, until now, compliance with the criminal laws governing the writing of prescriptions for pain medication. Do you overprescribe? Do you know what it means to overprescribe? What does the law in your state say? What does federal law say? What standards does your state’s Medical Board apply? What do you have to do now, to try and avoid or minimize problems later? What are the “recommendations” that suddenly morph into requirements when you’re placed under investigation – and which requirements you’re then accused of not having followed?

These are questions whose answers every healthcare provider deserves and needs to know. Let the Meister Law Offices help you verify, achieve and maintain criminal law compliance regarding prescription painkillers. PAINKILLER LAW: It’s good preventive medicine.

213.293.3737 The Meister Law Offices

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The National Center on Drug Abuse, affiliated with the U.S. Government’s National Institutes of Health, compiled and put out a statistic awhile ago that 5.1 million Americans had taken prescription painkillers in the past month for “nonmedical reasons.” The statistic, released in 2010, is still being turned to today by the USG and others as calls to action against healthcare providers who prescribe Schedule II through V pain medication. The government’s argument then and now is fundamentally flawed, and unless it’s confronted, it threatens to become the government’s next “Yellow Cake” speech and recklessly target and penalize innocent and ethical healthcare professionals. The Yellow Cake speech, delivered to the United Nations by former Gen. Colin Powell during the George W. Bush administration, was the 16-word pronouncement that Iraq possessed weapons of mass destruction as a result of obtaining nuclear material, or “yellow cake,” from an African nation. The intel, of course, turned out to be wrong, and Gen. Powell has repeatedly said that delivering that speech is the biggest regret of his entire career.

First, the Center’s statistic itself is dubious. Who are these 5.1 million Americans? Patients? People with current, valid prescriptions? People whose dose has been monitored by their doctors? How do those surveyed draw the line between “medical use” and “nonmedical use,” and was there a static definition of “nonmedical” utilized as a standard measure from person to person? Or was “nonmedical use” a completely subjective notion, varying widely from person to person surveyed? The statistic is a compelling read, but its foundation, upon the most rudimentary examination, is shaky.

Second, the statistic says nothing about whether the source of the “nonmedical” painkillers is the user’s healthcare provider. Were these lawfully prescribed pills? Black market resells? Internet Oxy? There is no connection made between user and healthcare provider.

Third, and most importantly, the government mistakenly draws this connection in its current pronouncements about the need to “crack down” or “do something” about prescription drug abuse. The Office of National Drug Control Policy, the DEA, states’ Medical Boards and other powerful agencies are looking for someone to blame, and they’re focusing “like lasers,” to borrow from former president Clinton, on doctors, osteopaths, physician’s assistants, and pharmacists. No doubt there are some corrupt providers, pill mills do exist, drug diversion onto the black market is real, and a lot of people are addicted to prescription painkillers. But government at all levels nationwide is taking a hamfisted, impulsive, under-informed and careless approach to complaints, investigations, license revocation proceedings, lawsuits and criminal prosecutions. And with the pressure coming from legislators, patient advocates and vocal critics of prescription painkillers, the ethical healthcare provider should expect to come under investigative scrutiny even if in a different enforcement environment no official attention would be warranted.

Amid the swirling turbine of subpoenas, search warrants, legislation that second-guesses or replaces medical judgment, and other risks, healthcare providers must ensure that they are in full compliance with all criminal laws affecting and regulating prescription painkillers.

The Meister Law Offices has pioneered a critical new area of criminal defense – PAINKILLER LAW: CRIMINAL LAW COMPLIANCE FOR HEALTHCARE PROVIDERS. We are here to help. We help you verify, achieve and maintain compliance, so you can practice knowing you’re doing right by your patients and the law, and so if the law comes knocking anyway, you’re ready and able to stand up for yourself.

Call us today at 213.293.3737 for a free consultation, or write to us at

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