L. Joseph Parker is a research physician.

Physicians behind bars: the consequences of medical misjustice

Physician
October 19, 2023

In 1985, Mr. Charles McCrory was on trial. Charles had found his wife dead, and her family was convinced that he was responsible, despite the fact that Charles denied any involvement and just wanted to grieve in peace. There was no real evidence against him, but the state had an ace up its sleeve in the form of Dr. Richard Souviron.

Dr. Souviron was a forensic odontologist, which is a dentist …

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Physicians behind bars: the consequences of medical misjustice

A breakthrough in chronic pain detection?

Conditions
October 16, 2023

Recently, a group of researchers at the University of California, San Francisco, reported that they may have found the holy grail of pain management. They accomplished this by performing “the first-in-human, long-term direct brain measurement of chronic pain-related neural activity.”

Physicians have long sought a reliable way to detect and track the presence of chronic pain and its response to treatment but have failed completely so far. Old tropes like …

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A breakthrough in chronic pain detection?

Codeine cough syrup: a controversial classification

Meds
October 13, 2023

Did you know that promethazine with codeine cough syrup had a high risk of diversion and high risk of addiction? I didn’t.

From my experience, this is the only effective prescription cough medicine available. Sure, you can prescribe what is essentially over-the-counter dextromethorphan. But be ready when the patient throws a fit because that’s what they’ve been using for the last several days or weeks, and it wasn’t effective. Tessalon Perles …

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Codeine cough syrup: a controversial classification

Balancing medical ethics in opioid treatment

Physician
October 9, 2023

What is a legitimate medical reason to prescribe an opioid medication today? For pain or addiction? Who decides which patients are worthy of treatment? This question is not just of academic interest. Any prescribing medical provider today must constantly live in fear that a law enforcement agent somewhere will disagree with the prescriber’s answer to these questions. On its face, it seems simple. If a patient has severe pain, a …

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Balancing medical ethics in opioid treatment

Navigating medication prescriptions in a DEA-observed world

Physician
October 8, 2023

I sit in my clinic office, looking at today’s schedule. It’s a nice office with lots of white and pastels, modern furniture, an up-to-date computer, and a desk. I always wanted my clinic to look like something from the future, and now, after twelve years, it finally does. Besides the screen on my desk, there is a large screen on the wall to my left, the patient’s right. From my …

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Navigating medication prescriptions in a DEA-observed world

Vague criteria can lead to misdiagnosis and prison

Conditions
September 24, 2023

The definition of addiction, now called substance use disorder, has varied greatly over time. The first edition of the Diagnostic and Statistical Manual, from 1952, didn’t include specific diagnostic criteria for this condition. Over the next sixty years, the DSM went through six revisions, with a slow evolution of the terms “substance abuse” and “dependence.” The first was limited to substance use causing social and occupational problems, while the last …

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Vague criteria can lead to misdiagnosis and prison

Balancing opioid medication in chronic pain

Conditions
September 13, 2023

She walked in with a cane, bent over like a question mark. She was in her seventies and as sweet as people in that age group tend to be. I think most of the cranky ones don’t make it that far. She was something of an emergency because her doctor had just passed away, and it was time to refill her medications. It would not be safe for her to …

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Balancing opioid medication in chronic pain

Doctor convictions: Unmasking the 3 threats you need to know

Physician
September 10, 2023

Why would anyone lie about you? And what makes you prone to conviction? There are three types of people that will absolutely bring your world crashing down on you, and you need to know who they are. But first, we need to understand the formula that prosecutors have developed to target doctors.

Prosecutors go after doctors because they are easy targets. The formula developed by prosecutors has three steps: First, make …

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Doctor convictions: Unmasking the 3 threats you need to know

DEA’s criteria for identifying pill mills: a physician’s analysis

Physician
August 22, 2023

Many physicians reading this forum treat pain and addiction and may wonder what criteria the DEA believes to be indicative of a pill mill. The following is from a motion filed in federal court regarding the prosecution of a physician:

The government claimed in the motion that pill mills, “have been found to have common characteristics, including some or all of the following”:

DEA’s criteria for identifying pill mills: a physician’s analysis

The persecution of pain management doctors

Physician
July 25, 2023

The call came in during a busy workday. My comprehensive primary care clinic had been built over a decade of hard work and had a general practice clinic staffed by a very capable former surgeon and several nurse practitioners, as well as a pain management program and an addiction treatment clinic. We also had several counselors on staff. I immediately recognized the voice on the other end of the line …

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The persecution of pain management doctors

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