Tennessee Dr. Ralph Thomas Reach is a vastly experienced addiction medicine physician. Continued application of his knowledge and pioneering experience could improve the opioid drug overdose death rate in his state. Unfortunately, the state government revoked his medical license, and Dr. Reach will soon begin serving six months in federal prison, followed by 18 months under house arrest.
After obtaining approval from the Drug Enforcement Administration, Dr. Reach had been treating people with opioid use disorder with a proven form of medication-assisted treatment, buprenorphine. Buprenorphine is such an effective treatment that, in December 2022, Congress ordered the DEA to remove barriers to clinicians prescribing the drug.
Nevertheless, as happens all too often, the DEA raided Dr. Reach’s clinic and ultimately put an end to his addiction treatment practice. Now, patients with addiction have one less doctor from whom to seek help. Stories like this are frightening away clinicians who would like to treat the estimated 7.6 million people suffering from opioid use disorder.
Dr. Reach had established the Watauga Recovery Centers network in the tri-state area of Appalachia (Tennessee, Virginia, and North Carolina). His centers were closed on May 2, 2018, following a dramatic and highly publicized by Drug Enforcement Administration agents.
Ignoring the immediate needs of Reach’s Watauga patients, the DEA arrested Reach and deceptively charged him with numerous unsubstantiated felonies. Reach had hurt or killed nobody, committed no malpractice, and no financial or medical insurance fraud was uncovered. Loss of income and his legal expenses led him to bankruptcy. Reach sold Watauga clinics at a harsh discount to for-profit corporate health care interests. Eventually, hoping to retain his medical license, Reach accepted a plea bargain, and was sentenced to prison for violating three misdemeanors related to pharmaceutical labeling procedures in his clinics.
The Watauga Recovery Centers provided care, operating in the spirit of the successful Tennessee Antinarcotic Act of 1913, as described by then State Food and Drugs Commissioner Lucius Polk Brown. At that time, only morphine was available to relieve heroin hunger and reduce opiate craving.
Brown’s student Willis P. Butler, MD, organized a similar treatment program in Shreveport, LA (1919-1923), describing its success in the American Medicine Journal in 1922.
Decades later, Dr. Butler recounted the details of successful medication-assisted addiction treatment in Shreveport for a 1974 Drug Council report, which remains relevant today. Dr. Benjamin Rush, the “Father of American Medicine” and one of the nation’s founders, originally described substance use disorders and proposed “to rescue persons affected with them from the arm of the law, and to render them the subjects of the kind and lenient hand of medicine.”
Sadly, Dr. Butler’s successful Shreveport clinics were closed 100 years ago, because federal drug prohibition agents, contradicting long-established medical opinion, had decided that narcotic addiction was a willful act and not a psychiatric illness. Federal agents ended medication-assisted treatment as a legitimate therapy and, by usurping control over medical treatment, initiated the stigmatization and criminalization we now must find a way to change.
The Federal Bureau of Narcotics became the Drug Enforcement Administration (DEA) in the 1970s after Congress passed the Controlled Substances Act. A century after closing Dr. Butler’s clinics in Shreveport, Louisiana, the raid on Dr. Reach’s practice suggests the DEA still believes, despite all evidence to the contrary, that extensively publicized paramilitary-style shock and awe raids will decrease the overdose death rate and reduce the demand for illicit drugs.
Vulnerable drug-dependent people die from drug overdoses at alarming rates. One reason is that they are stigmatized, and effective treatment is unavailable. The DEA enforces regulatory obstacles that block access to buprenorphine and methadone medication-assisted treatment programs. Criminalization and stigmatization are further barriers to medical care. The century of intimidation, persecution, and prosecution of physicians who attempt to relieve the suffering of drug dependence is thoroughly explained in the Cato Institute white paper “Cops Practicing Medicine.”
Treating opioid addiction with medications such as buprenorphine and methadone saves lives, and decreases the demand for black-market drugs. Although Congress has removed obstacles to prescribing buprenorphine to treat opioid use disorder, news reports of drug task force raids on addiction physicians like Tom Reach make other doctors fearful of providing medication-assisted treatment.
Without any typical process, such as advance notice of charges and an opportunity to be heard by the Board of Medical Examiners, Dr. Reach’s Tennessee medical license was revoked pursuant to a recently enacted, likely unconstitutional state law that precludes the Tennessee Board of Medical Examiners from deciding on Dr. Reach’s fitness to practice medicine.
Reach struggles to arrange reasonable legal costs to challenge the constitutionality of the Tennessee law. His impoverished financial state and reasonable fear of lengthy incarceration led him to plead guilty.
The 2018 DEA raid removed a competent, experienced, and forward-thinking addictionologist from practice in a region with extremely high rates of overdose death. Law enforcement agents have raided thousands of doctors and prosecuted them for easing the suffering of their patients. The demand for illicit narcotics like fentanyl and the overdose death rate continues to increase as a result of such DEA tactics.
Unless he receives a pardon, Dr. Ralph Thomas Reach will be in jail or under house arrest, instead of meeting with colleagues in Nashville, as he has done many times in the past, to inform and help guide strategies that reduce the overdose death rate. Substance use mortality, like an old-testament plague will not diminish until we improve access to treatment and reduce the fear-based stigmatization of substance use.
A.J. Reid Finlayson is a psychiatrist. Jeffrey A. Singer is a general surgeon. Peter R. Martin is a psychiatrist.
