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When Good-Faith Medicine Raises ‘Red Flags’

The DEA’s investigation of Forest Tennant tries to criminalize differences of opinion about pain treatment.

Forest Tennant, who has been treating and researching pain at his clinic in West Covina, California, since 1975, is well-known as an expert in the field, having published more than 200 articles in medical journals and given more than 130 presentations at professional conferences. According to the Drug Enforcement Administration (DEA), all of that was an elaborate cover for drug trafficking.

Or so you would have to surmise from the affidavit supporting the search warrant that the DEA served on Tennant's offices and home last week, which describes "invalid prescriptions," "red flags of diversion and fraud," and "combinations of drugs that are consistent with 'pill mill' prescribing practices." The allegations and insinuations show how the DEA has tried to criminalize differences of opinion about pain treatment, encouraging doctors to think about their legal exposure first and their patients second.

Tennant says the "red flags" perceived by the DEA are consistent with a practice like his, which specializes in treating severe, intractable pain caused by conditions such as arachnoiditis, Ehlers-Danlos syndrome, reflex sympathetic dystrophy, and post-viral neuropathy. "We only take people who have failed the standard treatments," he says.

Tennant's willingness to take hard cases explains why some of his patients live in other states, a fact the DEA considers suspicious. "We only see them in conjunction with their local doctors," he says.

In addition to severe pain, Tennant's patients often have metabolic abnormalities that make them less sensitive to opioids and have developed tolerance after years of pain treatment. Those factors explain the doses that struck the DEA as suspiciously high and the drug combinations it deemed reckless.

By the time Tennant starts treating them, his patients are already taking large doses of opioids, often in combination with muscle relaxants and benzodiazepines. "We didn't start anybody on high dosages," Tennant says. "We took them to study them to figure out how to get them off of high dosages, and that has remained our goal."

In nine out of 10 cases, Tennant says, he has been able to reduce patients' opioid doses substantially, by as much as 80 percent. At the same time, he defends the use of high doses for patients who need them, a stance that bothers the DEA.

The search warrant affidavit cites a 2009 article in which Tennant and two other doctors defended the prescription of "ultra-high opioid doses" for certain patients with severe chronic pain. The affidavit also notes that Tennant championed the California Pain Patient's Bill of Rights, a 1997 law affirming that "opiates can be an accepted treatment" for "severe intractable pain." The DEA seems to be arguing that Tennant's sincere medical opinions and advocacy on behalf of pain patients should be considered evidence of criminal activity.

The DEA suggests that speaking fees Tennant received from Insys, which makes the oral fentanyl spray Subsys, amounted to kickbacks. The DEA also implies that it's improper to prescribe Subsys for anything other than cancer pain, the application for which it was approved by the Food and Drug Administration.

Tennant notes that it's common practice for doctors who have experience with a drug to get paid for training colleagues to use it. He says Subsys "turned out to be somewhat disappointing," but he prescribes it for half a dozen patients who find it useful for breakthrough pain, including a few who do not have cancer—"off-label" uses that are perfectly legal.

Tennant, who has testified against "pill mills," says his clinic looks quite different: It has a six-hour intake process, sees a maximum of 10 people a day, and has "big thick charts" for its patients, who come with their families and tend to be middle-aged. He adds that his practice, which treats about 150 patients, has never had any overdoses, suicides, or diversion problems.

"I invite anybody to come in and see what we do, talk to our patients, see our financial records, talk to me," Tennant says. "My clinic is wide open."

© Copyright 2017 by Creators Syndicate Inc.

Watch Zach Weissmueller's video profile of Dr. Tennant, originally published on July 7, 2017:

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  • Telcontar the Wanderer||

    "The DEA also implies that it's improper to prescribe Subsys for anything other than cancer pain, the application for which it was approved by the Food and Drug Administration."

    And they say drug cartels never work together!

  • Pedestrian||

    The FDA is 2nd only to the CIA for corruption. [It] is squarely in the pockets of the drug companies.

  • SQRLSY One||

    Can a doctor sue the DEA for defamation? I'd like to see that tried... It would fit to a "T", here...

  • Cynical Asshole||

    "It's better for people to be forced to live with severe intractable pain than allow even the appearance of opioid abuse. Seriously, what part of 'opioid epidemic' do you people not understand?" - DEA

  • cravinbob||

    "Opioid" I do not understand, I think they refer to synthetic opiates but "epidemic" is being used incorrectly, we have to realize the DEA are not doctors or have medical degrees. Hmmm, not doctors.... Maybe they will be cancer patients some day and in pain...

  • C. S. P. Schofield||

    One can only hope...

    Vicious vermin.

  • Finrod||

    I want to see everyone at the DEA come down with crippling pain and be unable to get any legal drugs to relieve that pain.

  • ace_m82||

    I'm assuming that's what hell would look like for them.

  • Longtobefree||

    How could that happen? They have evidence lockers full of pain relievers that are OK for them, just not for you.

  • BYODB||

    When it really comes down to it, guys like Tennant are guilty of the crimes the DEA claims because what's honestly being outlawed are practices like his. It doesn't matter what his intent is, all the DEA cares about is making sure that practices like his don't exist.


    That isn't me supporting this bullshit, it's just the way it is. It was only a matter of time until he was shut down because the types of patients he was seeing are people the government honest-to-god don't give a single fuck about. As far as the government is concerned, those patients would be better off putting a bullet in their own head to end their pain.


    Disgusting as hell, but that's what happens when you consider inanimate substances to be evil in one circumstance and perfectly beneficial in another. It's a double standard in our laws that's inevitably going to cause dissonance.

  • Mitsima||

    ... those patients would be better off putting a bullet in their own head ...

    BATFEBGWCW* & CDC: Someone call us?


    *Bureau of Alcohol, Tobacco, Firearms, Bubblegum Wrappers, & Candle Wicks.

  • C. S. P. Schofield||

    I wait for is the pain patient who decides to put bullets in a bunch of DEA agents' heads. And the DEA will have the nerve to act surprised.

  • Unicorn Abattoir||

    We here at the DEA don't look kindly on good faith....

  • ace_m82||

    There are no possible problems with socialized medicine.

    None. At. All.

  • Telcontar the Wanderer||

    No, no, if Sessions or Reagan does it, it's not socialized medicine.

    Nor if it's Carrie Nation.

    {cocks C-96 Mauser}

    Understood?

  • Malvolio||

    "The search warrant affidavit cites a 2009 article in which Tennant and two other doctors defended the prescription of 'ultra-high opioid doses' for certain patients with severe chronic pain."

    Wow, that alone should be enough to have the search, and possibly the entire investigation, shit-canned. I don't remember any provision that allowed "petitioning the government for redress of grievance" to be the basis of a criminal investigation.

  • Petie Cue||

    This is the kind of MD you WANT to be treating you if you are in the kind of awful, horrible, excruciating, disabling, maddening pain that makes you need to be doped up at close to the lethal dose so you can function semi-normally. No overdoses or deaths? That's phenomenal for a pain-management doc! He should get a frickin' medal!

  • Petie Cue||

    This is the kind of MD you WANT to be treating you if you are in the kind of awful, horrible, excruciating, disabling, maddening pain that makes you need to be doped up at close to the lethal dose so you can function semi-normally. No overdoses or deaths? That's phenomenal for a pain-management doc! He should get a frickin' medal!

  • cravinbob||

    It is pretty fucking easy to make busts when the "suspect" has an office and pays a fee to the DEA to write prescriptions and receives the drugs from companies that are regulated and licensed by the government. If a doctor is over-prescribing the DEA will know immediately and if he is a pain doctor you can guess what he is prescribing. Nobody dies from opiate overdoses unless they mix it with alcohol or benzodiazepines or fentanyl.
    They are violating The Constitution so much it almost is gone, say goodnight.

  • cc2||

    I have a doctor friend in Detroit who was not dealing but who was perhaps careless about his patients. He was busted, had to give up his license and go to jail for a year. I shudder to think what I will do if I need pain meds.

  • texexpatriate||

    The DEA is another government agency free people can do without. Medical associations can govern medical practices. In this case the DEA is just looking for a conviction and its bureaucrats don't give a hoot who they hurt or how much the patients hurt.

  • Tionico||

    This "case" is a flaming example of the DEA manufacturing job security. They don't care a whit about any individual patients, all they care about is the APPEARANCE that they are "doing something". Never mind they sacrifice honest docs and others who are REALLY "doing something" to help folks.

    The disgusting thing is, NOWHERE in our Constitution is there any basis for the existence of the DEA. OR the FDA.

  • jvolpehoo||

    As long as money controls politics and the Pharma industry controls the FDA and DEA, this wont change. They are criminal organizations. But if the masses overwhelm their representatives with righteousness there just may be some change.

  • Moogator||

    The writing on the wall is more like graffiti, the media, Trump, & 535 assholes in Washington DC have no clue what they're doing and talking about. They're doing a great job in creating a REAL OPIOID CRISIS. When these morons have completely left legitimate chronic pain sufferers out in the cold, they'll have created new illicit drug cartels via people turning to seeking relief from street level dealers. The suicide rates will also follow suit when people can no longer function in a semi-normal lifestyle. I never thought I'd see my country so broken and corrupt, or citizens tolerate the elected officials ignore the Constitution they swore to protect. I believe that apathy brought us here, the good news is that the government is so fucked up that maybe those apathetic non voting pieces of shit will get off their asses and vote beyond their bullshit party lines.

  • Pedestrian||

    Oh but berry, berry profitable drugs will be the downfall of western society...don't ya'know ? Leave to the lawdogs to suspect everything.

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