The Drug Enforcement Administration raided the office and home of California pain specialist Forest Tennant on Wednesday. The incident may foretell a new chapter in the federal approach to opioid prescriptions in California, which has a more permissive framework than other states.
Tennant, whose West Covina clinic attracts pain patients from across the country who claim they can't get treatment anywhere else, was featured in a Reason TV video in July.
The DEA search warrant lists probable cause for distribution and possession with intent to distribute a controlled substance and health care fraud. Agents seized Tennant's medical records, computers, medications, and financial records. The warrant also names United Pharmacy, which has supplied many of Tennant's patients with their medications. The DEA quotes consultants who speculate that he may be running a "pill mill," over prescribing pain medications for profit.
The DEA also alleges that Tennant may be taking kickbacks from the pharmaceutical company Insys, which manufactures a fentanyl-based medicine called Subsys. Tennant admits to earning speaking fees from Insys, which recently settled a lawsuit in Massachusetts for similar pay-for-play allegations. But, according to Tennant, his last paid speech for the company was in 2015 and he's prescribed Subys before and since this "short speaking endeavor."
Fentanyl is a powerful opioid considered by some to be deadlier than heroin as a street drug, but in a medical context the FDA approved the use of Subsys as a palliative for cancer patients. The warrant singles out two patients prescribed Subsys by Tennant, one of whom doesn't have cancer. Tennant says he was prescribing the drug off-label, or in a way not explicitly approved by the FDA, which is legal. The FDA, however, recently added additional restrictions on fentanyl medications.
"Is prescribing off-label or accepting speaking fees a crime?" Tennant said in a statement emailed to Reason.
Many opioid overdoses occur from a combination of three drugs: narcotics, benzodiazepines, and the muscle relaxant Soma. A consultant quoted in the warrant says a number of Tennant's patients were prescribed this "holy trinity" and called it a "red flag."
Tennant says his clinic is known for accepting difficult patients turned away by other doctors, and that the DEA failed to throughly examine his treatment methods. Tennant says "in recent years" his clinic "has not had an overdose death," something the warrant does not allege.
The warrant also makes note of Tennant's outspoken public defense of opioids, noting that he helped draft California's Pain Patient Bill of Rights, which states that "opiates can be an accepted treatment for patients in severe chronic intractable pain who have not obtained relief from any other means of treatment" and that "a patient suffering from severe chronic intractable pain has the option to request or reject the use of any or all modalities to relieve his or her pain."
Tennant, who's published scathing critiques of the government's approach to the opioid problem, believes the DEA is failing to recognize the harmful effects persecuting doctors who prescribe opioids is having on legitimate pain patients.
"I take the Hippocratic oath seriously, that my job is to relieve pain and suffering," says Tennant.