On August 8, 2023, DEA agents shut down the Oak Hill Hometown Pharmacy in the Southern District of West Virginia. Their crime? Having filled more than 2,000 prescriptions for Subutex over more than two years “in the face of obvious red flags of drug abuse and diversion,” according to the U.S. Attorney for that district. I guess someone needs to explain to the government what the heck Subutex is prescribed for. It is for addiction! Of course, it should be going to people with red flags for drug abuse. If it was not going to people with red flags for drug abuse, that might be an issue. Apparently, the government’s AI algorithms had spotted “too much” medication being used somewhere and labeled it as “an imminent danger to public health and safety.”
I’m confused. Is the abuse of drugs an imminent threat to public health and safety? And isn’t buprenorphine considered a “safe” alternative to full opioid agonists? Research has shown that, although it has side effects like all medications, it can prevent death by overdose among patients with opioid use disorder. Why would you not want this medication to be readily available? As for diversion: What do they think addiction is? An optional state of mind? The definition of full addiction includes the uncontrollable urge to engage in the use of a substance or activity to create the sensation of euphoria. Dysphoria and withdrawals are a consequence of long-time use with abrupt cessation. Normal for people on opiate therapy, a possibly deadly consequence for those with addiction.
Medications like Subutex can ease withdrawals and prevent secondary problems like electrolyte abnormalities or opioid withdrawal-induced cardiomyopathy. The DEA did not even contend that any specific patient had abused or diverted Subutex or Suboxone. Suboxone is the combination of buprenorphine with naloxone, while Subutex is buprenorphine alone. Naloxone is Narcan, and it blocks the attachment of opioids to the receptor. Buprenorphine binds tightly enough to get around this, but common drugs of abuse, like heroin and fentanyl, do not, keeping them from exerting their effects. This protective effect can also cause precipitated or abrupt severe withdrawals if given to someone with any drugs still in their system. For this reason, Subutex is often used to start treatment or in people with an intolerance to naloxone, while maintenance or long-term therapy is usually the combination.
The Oak Hill Hometown Pharmacy is in Fayette County and has been around since 2012, having survived the catastrophic floods that destroyed much of neighboring Greenbrier and Nicholas Counties and taking up the patients from those areas. This triggers one of the AI’s “red flags,” traveling a distance to receive care. West Virginia is a state hit hard by the illegal fentanyl flooding across our borders from Mexico and China, and the DEA’s response was to target many physicians treating pain and addiction, like the recently acquitted Dr. Kendall Hansen. This left pain patients with nowhere to receive treatment, and thousands went to the streets for relief, finding instead fake fentanyl-laced tablets produced in true “pill mills,” causing thousands of deaths. Others who survived were now branded as “addicts” and usually denied all pain treatment.
But in today’s hostile medical environment, even those labeled as having a substance use disorder often cannot fill their prescriptions because many pharmacies do not like to stock medications for addiction treatment, afraid it will draw law enforcement scrutiny. In light of what happened to Oak Hill, this fear is not unfounded. The owner of Oak Hill, Martin Njoku, has been working in that area for thirty years. I would also like to point out that the AI seems a tad biased against people of higher melanin expression. The name Njoku is of Igbo origin, which means the family is of Nigerian descent usually. I’m not saying the government is trying to be racist; I’m saying that they are succeeding incredibly well at being racist. A disproportionate number of physicians and pharmacists targeted by their vaunted AI “beast,” as they like to call it, are of African or other minority descent.
In 2019, Oak Hill took the DEA to court and ended up under the gavel of Judge Joseph Goodwin. Judge Goodwin appears to be of the mindset that a crime must be committed before you can deprive a citizen of the right to engage in commerce, and in this case, he could find none. The judge wrote that the pharmacy was filling prescriptions for a legal medication in an area where many doctors and pharmacies refuse to provide these medications due to the stigma associated with addiction. He also said, “The DEA has not pointed to a single instance of violation of the law.” But “simply offers what it sees as a suspicious pattern of the filling of lawful prescriptions for medication designed to treat opiate addiction.” The DEA had argued that Subutex is more likely to be diverted than Suboxone for the reasons discussed, but the Judge would have none of it, saying that the DEA had “not pointed to a single law or regulation that forbids prescribing Subutex to patients for whom the use of naloxone is safe.”
And this is the crux of the issue. The DEA wants to decide which medications are prescribed to which people. They want to throw a doctor or pharmacist in prison for prescribing any medication they don’t think the patient “needed” or “should have had.” This leaves doctors and pharmacists trying to figure out what might be in the heads of federal attorneys and agents when it comes to these medications. Many of them don’t approve of medication-assisted therapy for addiction at all, and I have heard them say so at conferences. Others don’t think “certain” people should have access to them or that if an addict can’t follow every rule, you “fire” them as patients or customers. These misconceptions about the proper practice of pharmacy and medicine are regularly destroying the lives of tens of thousands of Americans and, unless it is stopped, will kill hundreds of thousands more.
L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice. He currently serves as the chief science officer and operations officer, Advanced Research Concepts LLC, a pioneering company dedicated to propelling humanity into the realms of space exploration. At Advanced Research Concepts LLC, Dr. Parker leads a team of experts committed to developing innovative solutions for the complex challenges of space travel, including space transportation, energy storage, radiation shielding, artificial gravity, and space-related medical issues.
He can be reached on LinkedIn and YouTube.
