16 Key Findings about Arachnoiditis

By Forest Tennant, MD, PNN Columnist

We initiated the “Arachnoiditis Research Project” about 6 months ago. Our first goal was to pull together what we have learned to this point. While we continue to gather new information, this short report is an interim attempt to get our findings into the patient and practitioner communities.  

This report is not intended to be a formal protocol or guideline, but a way to pass on what we have found and determined during the course of our learnings.  Please keep in mind that research is neither static nor absolute.  In the future, newer findings will likely both clarify and expand upon our initial findings as presented in this report.    

Frankly, the response to the Arachnoiditis Research Project has been overwhelming. Each day we receive inquiries from patients and practitioners. Patients want help. Practitioners want to know what to do.

We have now reviewed over 300 MRI’s of Adhesive Arachnoiditis (AA) cases. We have received inquiries from 5 continents and over 17 countries. One thing is clear. The need to research and identify treatment for AA is here.  

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The goal of our research is to bring AA treatment to every community worldwide. How? By developing both diagnostic and treatment protocols that can be implemented by any medical practitioner in every community. Here is what we have learned so far:

16 Findings about Adhesive Arachnoiditis  

  1. Treatment efficacy is best achieved by the simultaneous administration of a three component medication program to suppress neuroinflammation, promote neuro-regeneration (nerve regrowth), and provide pain control to function. Medication for these three categories can be competently prescribed by any primary medical practitioner.  

  2. The most common cause of lumbar sacral AA is no longer dural puncture or trauma but intervertebral disc deterioration and spinal stenosis, which has forced cauda equina nerve roots to rub together causing friction, inflammation and adhesion formation.  

  3. Although there is no single symptom that uniquely identifies AA, there are a few symptoms that the majority of AA patients will usually have.  A simple 7-question screening questionnaire has been developed to help in identifying potential AA. If a patient answers “yes” to at least four of the seven questions in the test, they should immediately be evaluated by a physician to confirm the diagnosis.  

  4. A contrast MRI or high-resolution TESLA-3 or higher MRI can be used to visualize the cauda equina nerve roots and show abnormal swelling, displacement, clumping, and adhesions between clumps and the arachnoid layer of the spinal canal covering.  A greater number and larger size of clumps is generally associated with the most severe pain and neurologic impairments.  

  5. Some MRI’s are inconclusive or equivocal even though typical symptoms may be present.  In these cases, therapeutic trials of anti-neuroinflammatory drugs and pain control are warranted.  

  6. Spinal fluid flow impairment is common in AA patients and appears to be a cause of headache, blurred vision, nausea, and dizziness.  Obstruction or back-up of fluid can often be seen on an MRI.   

  7. Spinal fluid “seepage” throughout the damaged arachnoid layer and wall of the lumbar sacral spine covering is common and can be a cause of pain, tissue destruction and severe contraction that causes restriction of extension of arms and legs.  A physical sign of chronic seepage is indentation of tissues around the lumbar spine.  

  8. Pain due to AA appears to be a combination of two types: inflammatory and neuropathic (nerve damage).  It may also be centralized with what is called “descending” pain.  Proper pain control may require medicinal agents for all types.  

  9. There is currently no reliable laboratory test for the presence of active neuroinflammation, although certain markers (by-products of inflammation) such as C-Reactive Protein and myeloperoxidase may sometimes show in the blood.  Neuroinflammation may go into remission, but it may also act silently to cause progressive nerve root destruction.  

  10. Basic science and animal studies show the neuro-steroids (hormones made inside the spinal cord) have the basic functions of neuroinflammation suppression and neuro-regeneration stimulation.  Our observations clearly indicate that the patients who have improved the most have taken one or more of the hormones reported to reduce neuroinflammation and promote and support neuro-regeneration.  

  11. Patients who have had AA for longer than 5 years must rely on aggressive pain control to function and achieve recovery.  After a long period of untreated neuroinflammation, scarring of nerve roots is too severe for much regeneration to occur.  

  12. The drugs and hormones required for suppression of neuroinflammation and promotion of neuro-regeneration do not need to be taken daily to be effective and prevent side effects.  Medical practitioners have a choice of agents, and they can be competently prescribed by primary care practitioners.  We have found that three times a week dosing is usually quite sufficient.

  13. Persons who have developed AA without warning, trauma or chronic disc disease have often been found to have a genetic connective tissue disorder of which the most common are Ehlers-Danlos syndromes.  

  14. Cervical neck arachnoiditis is primarily a clinical and presumed diagnosis as there are no nerve roots to clump and observe on MRI.  The key MRI finding is spinal fluid flow obstruction and the major clinical symptom is extreme pain on neck flexing.  

  15. Only ketorolac among the anti-inflammatories, and methylprednisolone among the corticoids are routinely effective in AA.  Other anti-inflammatories and corticoids either do not cross the blood brain barrier or therapeutically attach to glial cell receptors.  

  16. Some seemingly unrelated compounds found to suppress microglial inflammation in animal and invitro studies also appear to have therapeutic benefit as neuroinflammatory suppressors in AA patients.  These include pentoxifylline, acetazolamide, minocycline and metformin.

The Tennant Foundation has also released an enhanced protocol for primary care physicians who treat AA patients. You can find the protocols and research reports on our website.

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Forest Tennant, MD, MPH, DrPH, has retired from clinical practice but continues his groundbreaking research on the treatment of intractable pain and arachnoiditis.

This report is provided as a public service by the Arachnoiditis Research and Education Project of the Tennant Foundation and is republished with permission. Correspondence should be sent to veractinc@msn.com

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Hormones & Pain Care: What Every Patient Should Know

By Forest Tennant, MD, Guest Columnist

As we start the year 2019, every chronic pain patient needs to know the status of hormones and pain care. Unfortunately, the recent hysteria over opioids has obscured the positive advances in the understanding and application of hormonal care to the relief and recovery of pain patients.

In fact, research and clinical experience is starting to revolutionize the way I personally think about pain care. Hormones are showing us the natural, biologic way the body deals with pain and injury. They are clearly the way forward.

Why the Excitement Over Hormones?

Hormones have recently been discovered to be made in the brain and spinal cord (central nervous system – CNS). Some hormones are made that have the specific job and function to protect (“neuroprotection”) CNS tissue from injury and to regrow the injured tissue (“neuroregeneration”). These hormones are collectively called “neurohormones.”

Intractable, chronic pain is actually a type of poisonous, electromagnetic energy that causes injury by producing inflammation (“neuroinflammation”) in the CNS and implanting the pain (e.g. “centralization”) so as to make it constantly (“24/7”) present.

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The process is similar to dropping acid on your skin which burns and causes inflammation to be followed by tissue destruction and scar formation. Fortunately, some neurohormones are made in the CNS to stop the pain, inflammation, tissue destruction and scarring process and rebuild the nerve cell network in the CNS.

Until recently, we physicians didn’t have a clue on how to enhance the natural, biologic hormonal system to help pain patients.

Excitement over neurohormones has really been enhanced by research in rats that had their spinal cords cut so that they walked around their cages dragging their hind legs. They were given some neurohormones which healed their spinal cords to the point that they could normally walk.

Other animal research studies using different test models with CNS tissue have also shown the power of specific hormones to heal and regrow brain and spinal cord nerve cells. This author can’t speak for others, but, in my opinion, these research studies are so compelling that hormone use in pain care has got to be fully investigated.

Are We Making Headway?

Absolutely, yes! First, eight specific hormones made in the CNS have been identified that produce healing effects in animals and show benefit in early clinical trials with chronic pain patients. These early trials indicate that some neurohormones can reduce pain and produce healing and curative neuroregeneration effects.

Six of these hormones are collectively known as “neurosteroids.” Don’t let the term “steroid” raise your eyebrows as it refers only to the chemical structure and not the complications of cortisone-type drugs. Some of the neurosteroids are known to the lay person such as estradiol, progesterone, and testosterone.

Two of the hormones produced in the CNS that control pain but are not classified as a “neurosteroid” are human chorionic gonadotropin (HCG) and oxytocin.

CENTRAL NERVOUS SYSTEM HORMONES

  • ALLOPREGNANOLONE
  • ESTRADIOL
  • DEHYDROEPIANDROSTERONE (DHEA)
  • HUMAN CHORIONIC GONADOTROPIN (HCG)
  • OXYTOCIN
  • PREGNENOLONE
  • PROGESTERONE
  • TESTOSTERONE

Due to all the controversies surrounding opioids and pain treatment, one would never know we have, in the past couple of years, made serious headway with hormones and pain care. Medical science has discovered which hormones reduce chronic pain and how the hormones can be prescribed. The overall hormone advance in pain care can, however, be generally summarized in that one or more of the neurohormones can be administered to provide some curative and regenerative benefit in essentially every chronic pain patient.

Replenishment of Deficient Hormones

The production of hormones made in the CNS can be assessed by blood tests which are available in every commercial, community laboratory. The amount of hormone in your blood stream is a pooled amount of hormone made in the CNS and in the glands; adrenals, ovary, and gonads (ovary and testicles).

I recommend a hormone blood test panel of these 6 hormones: cortisol, DHEA, estradiol, pregnenolone, progesterone, and testosterone. If any are low, they should be replenished. Why? Severe chronic pain may overwhelm the production of one or more of these hormones.

If you take opioids and other symptomatic pain medications such as antidepressants and muscle relaxants, you may actually suppress the production of some hormones, particularly testosterone, DHEA, and pregnenolone.

I highly recommend that every chronic pain patient have a hormone blood panel test at least twice a year and replenish any hormone that is low in the blood stream.
— Dr. Forest Tennant

The reason you must replace any deficient hormone is because all 6 of them activate pain centers (“receptors”) in the CNS to reduce pain and produce a healing and curative effect. These hormones act as sort of a co-factor or “booster” of symptomatic pain relievers such as opioids and muscle relaxants. I highly recommend that every chronic pain patient have a hormone blood panel test at least twice a year and replenish any hormone that is low in the blood stream.

The Pregnancy Connection

A couple of years ago I was presenting a scientific poster at a medical meeting on some of my hormone research. An old friend came up and asked, “What took you so long?”

I initially thought he was insulting me. He wasn’t. He was lamenting, along with me, a sad fact. We should have long ago been studying the pregnancy hormones, HCG and oxytocin, for everyday pain care.

Why? HCG in pregnancy is the hormone that grows the CNS in the embryo and fetus. Oxytocin is the natural pain reliever in pregnancy that allows a big “tumor” to grow in the abdomen without death-dealing pain. Also, oxytocin surges at the time of delivery to make sure that pain doesn’t kill the expectant mother.

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With such obvious knowledge about natural pain relief in pregnancy, we should have tested these hormones for severe, chronic pain problems before now. Do they work? Yes. Long-term HCG use (over 60 days) is proving most effective in reducing pain and restoring function in some patients with adhesive arachnoiditis and other severe pain problems. Oxytocin is an effective short-term pain reliever that can be taken for pain flares. It can even be taken with symptomatic pain relievers like aspirin, acetaminophen, or a stimulant to help a patient avoid opioids.

Goodbye Symptomatic Treatments

Until the hormones came our way, you never heard much about “symptomatic” versus “curative” care. Why? Up until the discovery that hormones are made inside the CNS and produce curative effects, about all we could do was prescribe symptomatic pain relievers such as opioids, muscle relaxants, and anti-seizure (“neuropathic”) agents. There was no need or hope that we can permanently reduce severe chronic pain, much less hold out a hope for cure or near cure.

Chronic pain patients are beginning to use DHEA, pregnenolone, testosterone, estradiol, progesterone, and HCG on a long-term basis. Dosages are beginning to be determined. For example, DHEA requires a dosage of 200 mg or more each day. Pregnenolone requires 100 mg or more. Patients report reduced levels of pain, fatigue, and depression.

Although few controlled studies have yet been done, the open-label clinical trials are impressive and clearly call for chronic pain patients to get started with the neurohormones that are being found to be beneficial. Neurohormones have changed our thinking and old-hat beliefs.

Every severe chronic pain patient needs to know they can probably do a lot of mending with hormonal care. Be, however, clearly advised. Hormones can mend a lot of damaged nerve tissue, but they can’t fix scar tissue once it sets in.

So far at my clinic site, we have around 60 to 70 people on oxytocin. Early results look good so far. Many are also on DHEA and pregnenolone as well. The treatment seems to be working.
— Nurse practitioner

Unfortunately, millions of severe, chronic pain patients have had no option in the past couple of decades except to take symptomatic medication and use such devices as electrical stimulators.

Even long-standing severe chronic pain patients who are on opioids, however, can almost always benefit from one or more hormones. Most important, I am finding that hormone administration is the best way in most chronic pain patients to reduce opioid dosages but still get good pain relief.

Therapeutic Trials

One of my major purposes in writing this report is to encourage all chronic pain patients to embark upon a search for one or more hormonal treatments that will reduce their pain, need for opioids, and yield a better life. Don’t wait for your medical practitioner to offer hormone testing or treatment. To many overworked medical practitioners, such a request may be considered a real nuisance or even a threat.

Be prepared. Check with other patients in your social media group. Know what you need. Make it easy on your medic. Please share with your social media group this report and any materials you have about hormones and pain care. Most MD’s, NP’s, and PA’s will appreciate your preparation and desire to try something new on a short-term, trial basis.

Every chronic pain patient needs to know that all the hormonal agents described here can be safely tried for one month. This is known as a “therapeutic trial.” Specifically ask your medical practitioner for a one-month, therapeutic trial. In this manner you can find out if the hormone is right for you and whether you should continue with it past one month.

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Forest Tennant, MD, MPH, DrPH, recently retired from clinical practice but continues his groundbreaking research on the treatment of intractable pain and arachnoiditis. To download a complete copy of Dr. Tennant’s report on hormones and pain care, click here.

This report is provided as a public service by the Arachnoiditis Research and Education Project of the Tennant Foundation and is republished with permission. Correspondence should be sent to veractinc@msn.com

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Former Tennant Patients Get New Doctor

By Pat Anson, PNN Editor

At a time when many pain patients have difficulty finding doctors willing to treat them, some of the sickest and most complicated pain patients in the U.S. have found a new physician. Or to be more precise, she found them.

Dr. Margaret Aranda is treating former patients of Dr. Forest Tennant, a prominent California pain physician who recently retired from clinical practice.  Tennant was seeing about 150 patients with severe intractable pain at his West Covina pain clinic. Most suffer from arachnoiditis, a chronic and painful disease of the spinal cord, and traveled to California from out-of-state because they could not find effective treatment locally.

Tennant, who is 77, is a beloved figure in the pain community. He was forced into retirement after the DEA raided his clinic last year and alleged he was running a pill mill. No charges were ever filed, but Tennant reluctantly agreed to close his clinic on the advice of his lawyer and doctor. That’s when Aranda stepped in and offered to take on Tennant’s patients.

“I feel very happy to be here and to be doing this and to feel qualified to do it because of my experience, my background and my education. But I think the thing I love the most is the connection I have with patients who understand that I’ve been through a lot myself,” said Aranda, an anesthesiologist whose medical career was put on hold for several years while she recovered from a car accident that left her with traumatic brain injuries.

“They just seem be relieved that they can talk to somebody who knows what it feels like. I think Dr. Tennant did that for them too. He wasn’t sick like a lot us were sick, but he carried that empathy with him. I find this to be very spiritual. I feel like I’m in the right place at the right time in my life and everything I went through prepared me for this.”

DR. MARGARET ARANDA

DR. MARGARET ARANDA

Tennant had success treating patients with an unusual combination of high dose opioid prescriptions, hormones, anti-inflammatory drugs and other medications, which Aranda plans to continue.

“I’m working to decrease the opioids as much as possible. For some patients that’s totally impossible, for others it’s not,” she told PNN. “I really think what we’re doing is redefining palliative care. I tell people this isn’t a pain clinic. This is a ‘keep you out of a wheelchair’ clinic. Keep you in the family. Keep you getting out of your house here and there.”

“Dr. Aranda is very intelligent and picked up on the scientific precepts of this disease and other things very rapidly,” says Tennant. “I was tickled to death the way she’s caught on to all this and knows how to carry on everything I was doing. Plus, she’s improving a lot of things I was doing.”

Under a Microscope

Aranda admits being a little worried about being scrutinized by the DEA.

“Of course, that would be the natural inclination I think for anyone in my field. It’s a little bit scary to walk in the shoes of a man who is so well known and beloved by everyone and had issues with the DEA I think most people felt were unfounded,” Aranda said.

“I am of course very concerned that they could be looking at me with a microscope. Or a double and triple microscope. But I think they already know our patient population and they now understand that we do have some of the sickest patients in the country. That’s why they come to us from all over. And so, we’re just careful.”

While Tennant operated his clinic basically as a charity, Aranda is “cash only” and will not accept medical insurance.  She is temporarily seeing patients at a clinic in Malibu but is looking for a permanent location.

Like Tennant, Aranda is willing to treat patients from out-of-state, including those who suffer from severe intractable pain. Patients interested in seeing Aranda can reach her at (800) 992-9280.   

DR. FOREST TENNANT

DR. FOREST TENNANT

As for Tennant, he’s not quite ready to retire completely. He plans to continue researching arachnoiditis, a progressive and incurable disease that often begins when the spinal cord is damaged during surgery or punctured by a misplaced needle during an epidural steroid injection.

Inflammation sets in and can spiral out of control, forming scar tissue that cause spinal nerves to stick together. That leads to adhesive arachnoiditis and neurological problems, which can cause burning or stinging pain that can be felt from head to toe.

Arachnoiditis is poorly understood and often misdiagnosed as “failed back syndrome.” Tennant estimates as many as a million Americans may have it. Few doctors are trained to recognize the symptoms or know how to treat it.

“I’m going to be spending my time trying to research and educate on arachanoiditis. I think it’s the biggest, most severe pain problem we have,” says Tennant. “Before I hang up my spurs totally I want to make sure arachnoiditis is known to every family doctor and nurse practitioner in every community in the country.”

Death of Pain Patient Blamed on DEA Raid

By Pat Anson, Editor

The Montana pain community is in mourning over the tragic death of Jennifer Adams, a 41-year old Helena woman who suffered from intractable chronic pain. The Lewis and Clark County coroner has not yet released a cause of death, but friends say Adams died from a self-inflicted gunshot wound April 25.

Adams, a former police officer and mother of an 11-year old boy, lived with severe back pain from Reflex Sympathetic Dystrophy (RSD) and arachnoiditis, two painful and incurable diseases in her spine.

Friends say in her final months Adams suffered from extreme anxiety – fearing that her relatively high dose of opioid pain medication would be reduced or stopped by doctors.

“Jennifer had horrible anxiety that was eating her alive,” says Kate Lamport, a close friend who also has arachnoiditis. “She hadn’t lost her meds. But the fear of it drove her crazy. Every day she was so afraid.

“She was beautiful, inside and out. Her little boy was her everything. And I know she felt like the walls were just closing around her.”

Adams was a patient of Dr. Forest Tennant, a prominent California pain physician, whose home and office were raided last November by agents with the Drug Enforcement Administration. A DEA search warrant alleged that Tennant must be running a drug trafficking organization because many of his patients came from out-of-state and were on high doses of opioid medication.

JENNIFER ADAMS

JENNIFER ADAMS

Tennant, who has not been charged with a crime and denies any wrongdoing, recently announced plans to retire and close his clinic, in part because of the DEA investigation. Tennant is a revered figure in the pain community because of his willingness to see patients like Adams who have intractable pain from rare diseases like arachnoiditis.

“She’s a patient I saw in consultation. She was on a very good (pain) regimen, had a very good nurse practitioner and had good support,” said Tennant. “It’s a tragic situation. She was a lovely person. She was ill, no question about it.”

Several of Adams’ friends and fellow patients told PNN that the DEA raid frightened her. Like many others in the pain community, Adams feared losing access to opioid medication because many doctors have cut back on prescribing or stopped treating pain altogether.  

KATE LAMPORT AND JENNIFER ADAMS

KATE LAMPORT AND JENNIFER ADAMS

“There’s more (suicides) coming. I don’t know how many people I’ve talked to that have a backup plan. We are the unintended consequences of the DEA’s actions,” said Lamport.

“Every day you get online and there’s another chronic pain patient that took their life. There’s another 20 that lost their medication. And she knew she couldn’t be a mom or work without it. And she didn’t want to be a burden. She was very prideful.”

“Before the raid she was very positive, keep fighting, that type of attitude. And the last couple of months she hasn't really been talking to anyone really consistently like she was,” said Heather Ramsdell. “I would characterize her mood as somber and scared with what's going on in this world and with her pain progressing, worrying about care.”

“She did not deserve to die. It’s just ridiculous. An entirely preventable loss of life. I think she was just totally freaked out over what was happening,” said Gary Snook. “We’re not drug addicts. We’re just sick people.”

“I think that Jennifer is collateral damage in that heinous DEA raid on Dr. Tennant,” says Dr. Mark Ibsen, a Helena physician who used to treat Adams. “We have a way to prevent these suicides and we’re completely ignoring it. Treating the patients in pain would prevent these suicides.”

Tennant does not believe Adams’ death is connected to the DEA raid.

“People who want to make that claim, that’s just simply false,” Tennant told PNN. “I think she was upset by the raid, like a lot of people, but I don’t believe you can make any assumption that there’s any connection.

“People have a lot of complaints about the government, but I think in this case and I want to make it abundantly clear, there is no connection to her pain care, her practitioners, or the DEA. This appears to be an independent, random event in a state that’s got a very, very high suicide rate.”

Adams’ last appointment with Tennant was in January. He said she was responding well to treatment and did not have a return appointment.

‘Disgusted’ by DEA Search Warrant

PNN has obtained a copy of an email that Adams sent to one of Tennant’s lawyers. Adams wrote that she was “truly disgusted” by the DEA raid and the allegations made against Tennant. Her patient records were among those seized by DEA agents. The search warrant claimed patients must be selling their opioid medication and funneling the profits back to Tennant. 

“My intention was and is to let you know a bit about myself and let you know that I am truly disgusted after reading the search warrant. I am NOT a drug dealer! I am not part of a drug cartel. I do not provide kickbacks to Dr. Tennant and I do not share my prescriptions. This whole situation has turned my life upside down once again,” Adams wrote. 

“It needs to stop. Legally speaking, someone has got to put an end to this obscene attack on patients with intractable pain, in particular; Adhesive Arachnoiditis.”

Adams said she developed adhesive arachnoiditis – a chronic inflammation of spinal nerves that causes them to stick together – after a failed back surgery and dozens of failed epidural injections. She also suffered a stroke during the birth of her son because of a botched epidural.

Before her career in law enforcement was cut short by chronic pain, Adams was a police officer in Helena and the first female deputy in Rosebud County, Montana.  She graduated third in her class at the Montana Law Enforcement Academy.

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She was proud of her career and felt the DEA raid unfairly stigmatized her and other Tennant patients. 

“I also have had all my accomplishments stained!” she wrote. “I have had to fight day after day to survive the devastation of this ever-changing disease! Please do not dismiss me.”

Donations to a college trust fund for Jennifer's son, Joshua "Tuff" Adams, can be made to First Interstate Bank, 3401 N. Montana Avenue, Helena, MT 59602. You can also call the bank at (406) 457-7171.

Doctors and Pharmacists Targeted in DEA Surge

By Pat Anson, Editor

The U.S. Drug Enforcement Administration has arrested 28 people and revoked the registrations of over a hundred others in a nationwide crackdown that targeted prescribers and pharmacies that dispense “disproportionally large amounts” of opioid medication.

For 45 days in February and March, a special team of DEA investigators searched a database of 80 million prescriptions, looking for suspicious orders and possible drug thefts.

The so-called “surge” resulted in 28 arrests, 54 search warrants, and 283 administrative actions against doctors and pharmacists.  The DEA registrations of 147 people were also revoked – meaning they can no longer prescribe, dispense or distribute controlled substances such as opioids.

The DEA said 4 medical doctors and 4 medical assistants were arrested, along with 20 people described as "non-registrant co-conspirators." The arrests were reported by the agency's offices in San Diego, Denver, Atlanta, Miami and Philadelphia.

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“DEA will use every criminal, civil, and regulatory tool possible to target, prosecute and shut down individuals and organizations responsible for the illegal distribution of addictive and potentially deadly pharmaceutical controlled substances,” Acting DEA Administrator Robert Patterson said in a statement.

“This surge effort has demonstrated an effective roadmap to proactively target illicit diversion of dangerous pharmaceuticals. DEA will continue to aggressively use this targeting playbook in continuing operations.”

The DEA surge is the latest in a series of steps taken by Attorney General Jeff Sessions to crackdown on opioid prescribing. Last August, Sessions ordered the formation of a new data analysis team, the Opioid Fraud and Abuse Detection Unit, to focus solely on opioid-related health care fraud. 

Sessions also assigned a dozen prosecutors to “hot spots” around the country where opioid addiction is common.  Last week the DEA said it would add 250 investigators to a task force assisting in those investigations.

Although overdose deaths are primarily caused by illicit drugs such as fentanyl, heroin and cocaine, federal law enforcement efforts appear focused on opioid prescribing. Doctors and pharmacists are easier to target because they are already in DEA databases, as opposed to drug dealers and smugglers operating in the black market.   

As PNN has reported, the data mining of opioid prescriptions -- without examining the full context of who the medications were written for or why – can be problematic and misleading.

For example, last year the DEA raided the offices of Dr. Forest Tennant, a prominent California pain physician, because he had “very suspicious prescribing patterns.” Tennant only treated intractable pain patients, many from out-of-state, and often prescribed high doses of opioids because of their chronically poor health -- important facts that were omitted or ignored by DEA investigators.

Tennant has not been charged with a crime and denied any wrongdoing. Nevertheless, he retired this month due to the stress and uncertainty caused by the DEA investigation. About 150 of his patients now have to find new doctors, not a simple task in an age of hysteria over opioid medication.

In an interview with AARP, Sessions defended the use of data mining to uncover health care fraud.

“Some of the more blatant problems were highlighted in our Medicare fraud takedown recently where we had a sizable number of physicians that were overprescribing opioid pain pills which were not helping people get well, but instead were furthering an addiction being paid for by the federal taxpayers. This is a really bad thing,” Sessions said.

“It’s a little bit like these shysters who use direct mail and other ways to defraud people. They will keep doing it until they’re stopped. In other words, if we don’t stop them, they will keep finding more victims and seducing them.”

Dr. Forest Tennant Retiring Due to DEA Scrutiny

By Pat Anson, Editor

A prominent California pain physician and a longtime champion of the pain community has announced his retirement. Dr. Forest Tennant, and his wife and office manager, Miriam, have informed patients that they are closing their pain clinic in the Los Angeles suburb of West Covina, effective April 1.

“On strong legal and medical advice, as I am 77 and Miriam 76, we are closing the Veract Intractable Pain Medical Clinic and taking retirement. I will write no additional opioid prescriptions after this date,” Tennant wrote in a letter to patients. “We very much regret this situation as the clinic is filled with patients we consider beloved family and friends.”

Tennant’s retirement is largely due to an ongoing DEA investigation of his opioid prescribing practices.   DEA agents raided the Tennants’ home and clinic last November, while Tennant was testifying in Montana as a defense witness in the trial of doctor accused of negligent homicide in the overdose of two patients. The Tennants arrived home to find the front door of their home had been kicked in by DEA agents.

A DEA search warrant alleged that Tennant was part of a “drug trafficking organization” and had personally profited from the sale of high dose opioid prescriptions. Tennant has denied any wrongdoing and no charges have been filed against him, but the investigation remains open and the resulting stress and uncertainty have taken their toll.

“It’s hard to continue operating when they never closed my case, and so I’m going to retire and move on,” Tennant told PNN. “That’s on the advice of both my lawyers and my doctors."

DR. FOREST TENNANT  (courtesy montana public radio)

DR. FOREST TENNANT  (courtesy montana public radio)

Tennant is a revered figure in the pain community because of his willingness to treat patients with intractable pain who were unable to find effective treatment elsewhere or were abandoned by their doctors. Many travel to California from out-of-state, and some are in palliative care and near death.

Tennant and his colleague, Dr. Scott Guess, treat about 150 intractable pain patients with a complex formula of high dose opioid prescriptions, hormones, anti-inflammatory drugs and other medications. 

Tennant says the DEA effectively forced him into retirement by refusing to drop the case.   

“You can’t do the kind of work I do and operate in legal uncertainty,” Tennant said. "You’ve got to have legal backing to treat these individuals. And I don’t know what the law is anymore.”

‘Many Patients Will Die’

This was a difficult day for Tennant's patients -- as many see their lives dependent on his continued care and treatment.

“I believe many of Dr. Tennant’s patients will die because they will never find another doctor to treat their painful condition,” says Gary Snook, a Tennant patient who lives with adhesive arachnoiditis, a painful and incurable inflammation in his spinal nerves. “I haven't decided if I will even look for another doctor, nobody will take a patient like me. And to be honest with you, I am tired of looking, tired of being treated like an addict, tired of being treated like a curiosity and nothing more, not a human being with a serious health issue that deserves to be treated.

"I am completely devastated for myself and my family, for Dr. Tennant and Miriam, for his patients and their families, and for all those who could have benefited from his continued breakthrough treatments and research," said Denise Molohon, another Tennant patient who lives with arachnoiditis, in an email.

"But I am most deeply saddened today for the entire chronic pain community - both patients and providers - for the tsunami of injustices perpetrated by DOJ/DEA and CDC in their cruelty, ignorance and haste to appear as though they are fighting the opioid overdose epidemic by ruining the lives of many innocent physicians. Their combined actions have had the tragic result of harming untold millions and leading to the senseless, needless deaths of patients all across our country whose only fault was suffering from horrific, intractable pain."

"The government has stepped in and stopped doctors from treating patients. They have created a hostile work environment for physicians who refuse to conform. Physicians who refuse to let their patients suffer. Addiction is a huge problem but so is intractable pain, yet those of us who play by the rules are the ones who suffer," said Kate Lamport, a Tennant patient who has arachnoiditis.

"Dr. Tennant and Mrs. Tennant have been a Godsend to all whom have crossed their paths and will never be forgotten by the thousands of lives they have touched and saved. Our blood is not on their hands, it is on the hands of those who have taken Dr. Tennant and every other doctor from us by way of fear." 

“Forest and Miriam treated me like a son as they did all their family, their patients. They did their best to take care of us," added Snook. "How could any doctor do so and pay $1,000 an hour in legal fees just to defend himself from false charges from the DEA?”

Tennant is referring all of his patients to new doctors, but in an age when many physicians are afraid of prescribing opioids, its unlikely they'll find similar care elsewhere.  Tennant has operated his pain clinic basically as a charity for years and charged patients little, if anything. He and his wife live modestly, and drive cars that are nearly 30 years old.

“They (the DEA) think my clinic has been operated to make a great deal of money. Some years it loses money. The last two years, it actually lost money. We subsidize it,” Tennant explained.

‘Highly Suspicious’ Prescribing

One medical professional who has been critical of Tennant's prescribing practices is Dr. Timothy Munzing, a Kaiser Permanente family practice physician who was hired by the DEA to review Tennant’s prescriptions.

Munzing was quoted in a DEA search warrant saying it was suspicious that “many patients are traveling long distances to see Dr. Tennant” and that they were prescribed “extremely high numbers of pills/tablets.”

“I find to a high level of certainty that after review of the medical records… that Dr. Tennant failed to meet the requirements in prescribing these dangerous medications. These prescribing patterns are highly suspicious for medication abuse/and or diversion,” Munzing wrote.

Munzing has worked for several years as a consultant for the DEA and the Medical Board of California, creating a lucrative second career for himself.

dr. timothy munzing

dr. timothy munzing

According to GovTribe, a website that tracks payments to federal contractors, Munzing is paid $300 an hour by the DEA. In the past few months, Munzing has been paid over $250,000 by the DEA to review patient records and testify as an expert witness in DEA cases.

The agency recently created a task force to focus on doctors like Tennant who prescribe high doses of opioids. The task force appears focused solely on the dose and number of prescriptions, not on the quality of life of patients or whether they’ve been harmed.   

After three years of investigation, the DEA has not publicly produced evidence that any of Tennant’s patients have overdosed, been harmed by his treatments, or that they are selling their drugs.

Tennant says he and his wife plan to retire to their home state of Kansas, where they have real estate investments. Once out of the picture, he hopes the medical profession and law enforcement will someday come to a sensible approach about how to deal with patients who need high doses of opioids.

“I have learned that my personality and my image is such that I think its prohibiting a good debate and discussion as to how the country is going to deal with people with really severe pain,” he said.

For the record, Dr. Tennant and the Tennant Foundation have given financial support to Pain News Network and are currently sponsoring PNN’s Patient Resources section.  

Doctor Arrested for Off-Label Prescribing of Subsys

By Pat Anson, Editor

A Las Vegas pain management doctor has been arrested and charged with 29 counts of healthcare fraud and unlawful distribution of fentanyl.

Steven Wolper, MD, was indicted by a federal grand jury for illegally prescribing Subsys, a fentanyl-based oral spray, to 22 patients that the doctor falsely claimed had cancer. Most of the patients were Medicare beneficiaries. One died of an overdose after self-injecting Subsys.     

Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine.

The Food and Drug Administration has only approved Subsys for the treatment of breakthrough cancer pain. Although off-label prescribing of drugs is common in the medical profession, federal prosecutors maintain that “there are no off-label uses approved” for Subsys and that Holper prescribed it “without a legitimate medical purpose and outside the usual course of professional practice.”

One of Wolper’s patients – referred to as “Patient A” in the indictment -- received several prescriptions for Subsys starting in 2014. Two years later the patient died after using a syringe to inject leftover Subsys directly into their arm.

“Hundreds of Subsys canister sprays were found in and around Patient A’s bedroom, bathroom, work place, and vehicle after Patient A’s death,” the indictment says. “If Patient A had not used remaining fentanyl from the used Subsys canisters Patient A received from defendant Holper, Patient A would not have died when he/she did.”

If convicted, the 66-year old Holper faces up to 20 years in prison for illegal distribution of a controlled substance and 10 years for health care fraud.

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“Dr. Holper is charged with needlessly prescribing one of the deadliest forms of opioids and defrauding U.S. taxpayers,” said FBI Special Agent in Charge Christian Schrank. “With our law enforcement partners we will continue our fight to bring these suspected criminals to justice and protect our communities.”

Subsys has been blamed for hundreds of overdose deaths, and federal prosecutors have accused its manufacturer, Insys Therapeutics, of fraud and racketeering in promoting its use. The Arizona drug maker allegedly misled insurers into paying for Subsys and encouraged doctors to prescribe it off-label for non-cancer pain.

The government’s willingness to prosecute Dr. Holper and a handful of other doctors for the off-label prescribing of Subsys could have potentially troubling implications for Dr. Forrest Tennant, a prominent California pain physician whose home and pain clinic were raided by the DEA last November.

Tennant only treats intractable pain patients and makes no secret of the fact that he prescribed Subsys off-label to about two dozen of his patients in severe pain. He considers Subsys a useful medication to treat non-cancer patients  who would otherwise suffer without it.

“My contention is that its perfectly acceptable to prescribe (Subsys) off-label,” Tennant told PNN, adding that he has a letter from an FDA commissioner stating that fentanyl products are not prohibited from off-label use. “I think the number of doctors who prescribed Subsys off-label is up in the hundreds.”

Tennant has not been charged with a crime and has denied any wrongdoing. 

The grand jury indictment of Dr. Holper came one week after Attorney General Jeff Sessions said there would a be a 45-day “surge” in law enforcement efforts targeting doctors and pharmacists who prescribe and dispense high doses of opioid medication.

"Our great country has never before seen the levels of addiction and overdose deaths that we are suffering today. Sadly, some trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and exploit this crisis for cash -- with devastating consequences,” Sessions said in a news release announcing Holper’s indictment.

“Our goals at the Department of Justice for 2018 are to reduce the number of opioid prescriptions, the number of overdose deaths, and violent crime -- which is often drug-related. That's why I created the Opioid Fraud and Abuse Detection Unit and sent 12 top prosecutors to opioid hotspots around the country: to help us find the medical fraudsters who are flooding our streets with drugs. These prosecutors are already issuing indictments from Pittsburgh to Las Vegas.”

Feds Target Doctors and Pharmacies in New Crackdown

By Pat Anson, Editor

Over the next few weeks, the Drug Enforcement Administration will step up investigations of pharmacies and doctors found to be dispensing or prescribing suspicious amounts of opioid pain medication.

The so-called “surge” -- announced by Attorney General Jeff Sessions – is the latest in a series of steps the Justice Department has taken to combat the opioid crisis.

“Over the next 45 days, DEA will surge Special Agents, Diversion Investigators, and Intelligence Research Specialists to focus on pharmacies and prescribers who are dispensing unusual or disproportionate amounts of drugs,” Sessions said during a Tuesday speech to law enforcement officials in Louisville, KY.

“DEA collects some 80 million transaction reports every year from manufacturers and distributors of prescription drugs.  These reports contain information like distribution figures and inventory.  DEA will aggregate these numbers to find patterns, trends, statistical outliers -- and put them into targeting packages,” Sessions said.

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"That will help us make more arrests, secure more convictions -- and ultimately help us reduce the number of prescription drugs available for Americans to get addicted to or overdose from these dangerous drugs.”

But that kind of data mining of opioid prescriptions -- without examining the full context of who the medications were prescribed for or why – can be problematic and misleading.

For example, the DEA last year raided the offices of Dr. Forest Tennant, a prominent California pain physician, as well as two pharmacies regularly used by his patients. Tennant only treats intractable pain patients, many from out-of-state, and often prescribes high doses of opioids and other prescription drugs  because of their chronically poor health. Some of his patients are in palliative care and near death.

Those important facts were omitted or ignored by DEA investigators, who alleged in a search warrant that Tennant had “very suspicious prescribing patterns” and was part of a drug trafficking organization.

“It’s not like he’s just giving out high doses of medication and running a pill mill, like they said. That to me was the most asinine statement in that whole search warrant,” said Riley Holder, a disabled pharmacist with intractable pain who is one of Tennant’s patients.

Tennant has denied any wrongdoing and has not been charged with a crime.

Last August, Sessions ordered the formation of a new data analysis team, the Opioid Fraud and Abuse Detection Unit, to focus solely on opioid-related health care fraud.  He also assigned a dozen prosecutors to “hot spots” around the country where opioid addiction is common. In November, Sessions ordered all 94 U.S. Attorneys to designate an opioid coordinator to help spearhead anti-opioid strategies in their district.

FBI to Target Online Pharmacies

Sessions this week also announced the formation of a new FBI investigative team, called the Joint Criminal Opioid Darknet Enforcement (J-CODE) unit, which will focus on shutting down illegal online pharmacies. Dozens of FBI agents and intelligence analysts are being assigned to J-CODE.  

“Criminals think that they are safe on the darknet, but they are in for a rude awakening. We have already infiltrated their networks, and we are determined to bring them to justice,” Sessions said. “The J-CODE team will help us continue to shut down the online marketplaces that drug traffickers use and ultimately that will help us reduce addiction and overdoses across the nation.”

As PNN has reported, the online pharmacy business is booming. As many as 35,000 online pharmacies are operating worldwide, and over 90 percent are not in compliance with federal and state laws.  Many do not require a prescription, and about half are selling counterfeit painkillers and other fake medications. About 20 illegal online pharmacies are launched every day.

A staff report last week to the U.S. Senate's Subcommittee on Investigations found that it was relatively easy to find and order prescription drugs online. Senate investigators used Google search to find dozens of websites offering illegal opioids for purchase, including fentanyl and carfentanil. They also identified seven individuals who died from fentanyl-related overdoses after sending money and receiving packages from an online seller.

“I’m thrilled this is something the U.S. government is prioritizing and is starting to pay attention to,” says Libby Baney, Executive Director of the Alliance for Safe Online Pharmacies (ASOP), an industry supported non-profit. “The Internet is part of the problem right now when it comes to the opioid epidemic and it should be part of the solution.”

Baney told PNN that when illegal online pharmacies are shutdown, they often reappear under new domain names and website addresses. Many are also located in foreign countries and are outside the reach of U.S. law enforcement.

“It’s a game of whack-a-mole in some respects,” said Baney.  

Last year the Justice Department announced the seizure of the largest dark net marketplace in history, a site that hosted over 200,000 drug listings and was linked to numerous opioid overdoses, including the death of a 13-year old.

The Difference Between Intractable and Chronic Pain

By Forest Tennant, MD, DrPH

The current attempts by a number of parties to castigate and humiliate pain patients and their medical practitioners is not just pathetic and mostly false, it is dangerous to the fate and life of many intractable pain (IP) patients.  If it wasn’t so serious, some of the claims, biases and beliefs would make good comedy.

First and foremost there has been no discussion about the difference between intractable pain and chronic pain.  There really is no bigger issue. 

The proper identification and treatment of the IP patient is not only essential for the health and well-being of the IP patient, it is a major key to the prevention of overdoses and diversion of abusable drugs.  IP patients must have special care and monitoring.  

The basic definition of IP is a “moderate to severe, constant pain that has no known cure and requires daily medical treatment.” 

Chronic pain, on the other hand is a “mild to moderate, intermittent, recurring pain that does not require daily medical treatment.” While there are millions of persons with chronic pain, only about 10% are intractable.

The cause of “intractability” is two-fold:

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  1. The initial injury or disease which initiated IP was severe enough to cause a pathologic transformation of the microglial cells in the spinal cord and/or brain.  It is this transformation that produces neuroinflammation and the constancy of the pain.  This process is known as “centralization” or “central sensitivity.”
  2. To have enough injury to cause “centralization” one must have a most serious disease or condition of which the most common are: adhesive arachnoiditis, traumatic brain injury, reflex sympathetic dystrophy, post-viral encephalopathy, or a genetic disease such as Ehlers-Danlos Syndrome, porphyria, or sickle cell disease.    

Medical practitioners must have minimally-restricted prescribing authority and autonomy to adequately treat IP.  For example, the proper treatment of IP not only requires analgesics, opioids and non-opioid, but specific anti-inflammatory, hormonal, and corticosteroid agents that will cross the blood brain barrier and control inflamed and pathologic microglial cells.  Treatment of IP has to be individually tailored and may require non-standard, off-label, or an unusual treatment regimen.  

Make no mistake about it.  The new treatment approach to IP is quite effective in reducing pain, controlling neuroinflammation, and allowing patients to biologically function well enough to have a good quality of life.  Also be advised that the new IP approach is not just reducing pain but treating the underlying cause of pain.  Consequently, a lot of expensive procedures, therapies, and opioids are no longer needed. 

As long as I am practicing I will continue to push forward this new approach.

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Dr. Tennant specializes in the research and treatment of intractable pain at the Veract Intractable Pain Clinic in West Covina, California, which remains in operation after recently being raided by DEA agents. Many of Dr. Tennant's patients travel from out-of-state because they are unable to find effective treatment elsewhere.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Tennant Patients Live in Fear of DEA

By Pat Anson, Editor

Deborah Vallier is living proof that high doses of opioid medication can safely relieve pain and improve quality of life. The 42-year old Michigan woman says her chronic back pain was so bad before she started getting high dose opioids that she contemplated suicide.  

“I was so bad that I spent most of my time in bed. I didn’t leave my house for almost two years, except for doctor’s appointments,” Vallier says.

After seeing over a dozen doctors in her home state and getting little pain relief, Vallier flew to California last April to see Dr. Forest Tennant, a prominent pain specialist. 

“Now, because of Dr. Tennant, I’m able to go to (my son’s) high school football games. I’m able to go to his wrestling matches. I actually have some of my life back, where I’m not stuck in bed and thinking about suicide.”

It was Tennant who diagnosed Vallier with adhesive arachnoiditis, a disabling, incurable and painful inflammation of nerves in her spine. Tennant put Vallier on a regimen of hormones and opioid  medication – a dose more than double the highest amount recommended by the Centers for Disease Control and Prevention, which is 90mg morphine equivalent dose (MED).

dr. forest tennant

dr. forest tennant

“I would say I’m close to close to 200mg,” Vallier says.

That kind of high dose would be inappropriate – even dangerous – for most pain patients. But for Vallier and about 100 other intractable pain patients that Tennant sees, it’s not unusual at all. Tennant puts many on multiple medications that include opioids, anti-depressants, hormones, muscle relaxants and benzodiazepines, a class of anti-anxiety medication. Patients from 25 different states see Tennant and most consider him a life saver.

“I credit him with saving my life. Absolutely, no doubt,” says Dale Rice.

But to the Drug Enforcement Administration, those high doses of pain medication and multiple prescriptions to out-of-state patients are signs of criminal activity and drug diversion.  

In November, DEA agents raided Tennant’s home and pain clinic in West Covina, CA, using a search warrant that alleged Tennant was part of a drug trafficking organization and insinuated that his patients were selling their drugs on the black market. In early December, the DEA used another search warrant to raid Sunny Hills Pharmacy in Fullerton, CA, where 19 of Tennant’s patients get their prescriptions filled.

“I know based on my training and experience that patients traveling long distances to obtain controlled substance prescriptions is another ‘red flag’ of drug abuse and addiction. The out-of-state patients also received multiple opiate and benzodiazepine drug cocktails,” wrote lead DEA investigator Stephanie Kolb, who according to her LinkedIn profile was self-employed as a dog walker and pet groomer before she started working for the DEA in 2012.

“Either they’re extremely ignorant that patients have to travel out of state to find the top specialists, because no one in their area knows how to treat them, or they’re just trying to go after doctors and eliminate the ones that they see as a problem, the ones that are helping patients who  need high doses,” says Vallier. “We have failed all other treatments and there’s nowhere else to go. Why are they going after him?”

Judging by the search warrants, the medical experts hired by the DEA as consultants in the Tennant case seemed unfamiliar with the nature of his practice. In the Sunny Hills search warrant, Kolb quoted Dr. Timothy Munzing, a family practice physician who reviewed Tennant’s prescribing records.

dr. timothy munzing

dr. timothy munzing

Munzing noted that “many patients are traveling long distances to see Dr. Tennant” and thought it unusual that many were prescribed “extremely high numbers of pills/tablets.”

“I find to a high level of certainty that after review of the medical records… that Dr. Tennant failed to meet the requirements in prescribing these dangerous medications. These prescribing patterns are highly suspicious for medication abuse/and or diversion. If the patients are actually using all the medications prescribed, they are at high risk for addiction, overdose, and death,” Munzing wrote.

Munzing is an experienced family practice physician who has worked as a consultant for the DEA and the Medical Board of California for several years.

According to GovTribe, a website that tracks payments to federal contractors, Munzing is paid $300 an hour by the DEA to work as an expert witness and to review patient records. Munzing was paid about $45,000 by the DEA during the period Tennant's prescribing records were under review.   

Vallier says Munzing is not qualified to critique Tennant’s medical practice.

“This is almost like having a proctologist be the advisor for the American Dental Association. Just because he’s an MD does not mean he is trained for intractable pain,” she said.

‘I’m Afraid I’m Going to Die’

Tennant denies any wrongdoing, has not been charged with a crime and – after three years of investigation -- the DEA has not publicly produced evidence that any of his patients have overdosed, been harmed by his treatments, or that they are selling their drugs. Tennant’s clinic also remains open.

But the fallout from the DEA raids has frightened many of Tennant’s patients and left some without adequate medication. 53-year old Dale Rice used to get his prescriptions filled at Sunny Hills, but after the pharmacy was raided he was told to go elsewhere. Rice found another pharmacy in Rancho Cucamonga, but the pharmacist there is only willing to fill some of his high dose opioid prescriptions. Rice estimates he’s now only taking about half of his regular dose of opioids.

“I thought the hardest part was dealing with the insurance company, and now I can’t get a prescription filled,” says Rice, who suffers intractable pain from arachnoiditis, scoliosis, arthritis and failed back surgery. Like many of Tennant’s patients, Rice is also a rapid metabolizer of opioids and gets only a fraction of the pain relief other patients get from them.

“You pull the rug out from under me with all these medications and it’s hard on the body. Dr. Tennant told me I could die from adrenal failure, a stroke, a massive heart attack, anything like that,” Rice told PNN. “I’m afraid I’m going to die. I’m afraid I could drop dead right now.

“I predict by the end of the year I’ll be probably bedridden again, unless something changes.”

Another Tennant patient worried about her future is Trini Yeager, a 59-year old California woman who developed arachnoiditis after a failed back surgery and a misplaced epidural steroid injection into her spine. Once very fit and active, Yeager now has trouble walking and spends most of her day in bed.

“What’s going on is absolutely outlandish and just very corrupt in my opinion,” Yeager says. “I’m just shocked beyond belief that they would do this to Dr. Tennant.

“He is being crucified for cleaning up other doctor’s messes. That’s really what’s happening.”

Yeager takes multiple opioid medications at the highest doses available, and even then gets only limited pain relief. Asked what would happen if her dosage was brought within the CDC opioid guidelines, she spoke bluntly and without hesitation.

“I would commit suicide and I would post it publicly. And I would tell people that the DEA was responsible,” Yeager said. “The pain is so tremendous, I can’t even tell you. If they took my medications away or took them down, they would have a public suicide on their hands.”

Sunny Hills was one of 26 pharmacies recently targeted by the DEA in in “Operation Faux Pharmacy,” an investigation that focused on so-called rogue pharmacies in California, Nevada and Hawaii that the agency alleges “may have operated outside the bounds of legitimate medicine.”

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The agency made a public show out of the pharmacy raids, inviting television cameras to record DEA agents hauling medical records out of one Southern California pharmacy.

"I don't prescribe medication, doctors prescribe medication," pharmacy owner David Rubin told KNBC-TV. "I'm not like one of those pharmacies you read about on TV. Everything is documented everything is crosschecked with the doctors."

"We only went after the pharmacies that we thought were prescribing or putting drugs on the street that had no obvious medical reason to do so," said David Downing, the special agent in charge of the investigation.

The DEA may just be getting started. Attorney General Jeff Sessions recently ordered all U.S. Attorneys to appoint “opioid coordinators” in their districts to monitor opioid prescriptions and to convene local law enforcement task forces to identify more doctors and pharmacies for prosecution.

Ironically, a few days after the raid on Sunny Hills, a teenage drug courier was caught in San Ysidro, CA at the Mexican border attempting to smuggle illicit fentanyl into the U.S. Nearly 78 pounds of fentanyl -- a synthetic opioid up to 100 times more potent than morphine -- were found hidden inside a 2010 Ford Focus. Experts say that is enough fentanyl to kill 17 million people --- or half the state of California. 

Dr. Tennant and the Tennant Foundation have given financial support to Pain News Network and are currently sponsoring PNN’s Patient Resources section.