Author: Eli Kelley

A Discussion of the Ensuing Legal Issues

In the warrant to search Tenant’s premises, the DEA cited Tennant’s receipt of speaking fees from Insys (a drug manufacturer that was under investigation for illegal activities at the time) and prescription of fentanyl. However, these allegations seemed absurd since Dr. Tennant was not the only practitioner receiving speaking fees from pharmaceutical companies. Also, the last payment Dr. Tennant had received from Insys was in 2015, by which time the investigation had not been made public. In addition, the DEA also said that the fact that several of Dr. Tennant’s patients came to see him from distant places and raised a red flag on his practice.

However, Dr.Tennat’s patients report that he spends hours counseling and examining them. In addition, the process also involves a lot of paperwork. This is contrary to what goes on in a pill mill, which usually involves a quick exchange of prescriptions for money with little record-keeping or examination. The search warrant’s main evidence was that Dr. Tennant offered very high doses of opioids prescriptions to some patients. The document alleged that the extremely high dosage implied that the patients were selling the drugs. However, despite these allegations, the DEA provided no proof that such activity had taken place.

Therefore, it would seem that the only real crime committed by Dr. Tennant, is taking patients that other physicians had turned away. Unless there is irrefutable evidence that was not provided, the charges brought against Dr. Tennent were not intended for the safety of the public, but rather to send a message. For a person to be convicted for drug trafficking, the law requires that a doctor must intentionally and knowingly be a pusher instead of a physician — they shouldn’t be convicted on the grounds that a government agency doesn’t approve of their doses of opioid prescriptions or their political opinions on drug policy.

This is a case of medicine regulation by law enforcement agencies –and the criminalization of what in a different scenario would be a case of malpractice due to failure to abide by care guidelines. This implies that practitioners providing prescriptions they believe to be appropriate could easily find themselves being charged with drug trafficking. Consequently, even if there is no iota of doubt that a patient needs high doses for normality due to metabolic, genetic, tolerance, or other reasons, Physicians can’t decide whether such a prescription will be deemed legal.

Regardless of how controversial a physician is, prosecuting them for practicing their profession is legally unacceptable (just look at the Acceptance Now story of a few years ago). We should keep things this way for the safety of people with addiction and pain patients whose maintenance drugs treatment like methadone and suboxone is also DEA regulated. Otherwise, what will be the sense of educating medical practitioners if they can’t practice medicine?…

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The Fall of Dr. Tennant

Although Dr. Tennant has enjoyed a hugely successful career, the ride has been nothing near smooth sailing. In 1997, the federal government fined Tennant six hundred and twenty-five thousand dollars in regard to the methadone programs he was in charge of that had not complied with the notoriously rigorous guidelines on the dosing and storage of the medication. In the early 2000s, Dr. Tennant was accused of insurance fraud and later convicted. As a result, his medical license was put on a probationary period of 4 years. However, after the completion of his probationary period, the license was reinstated and Dr. Tennant continues to be one of the most respected doctors in his field.

Recently, several pain physicians have started to change their approach towards pain. In an article in the New England Journal of Medicine. One of the CDC’s pain specialists recommended pain patients use acceptance and coping techniques that essentially limit pain-related suffering and only reduce pain intensity secondarily. It is slowly becoming conventional wisdom that using opioids is not the most effective treatment for chronic pain. The AMA (American Medical Association) has even started advising physicians in the U.S. not to use the pain rating scale during the assessment of pain patients. Dr. Tennant did not take this advice very well, publicly stating that he was not on the same page with AMA on the issue. However, he does agree that the drug should only be used as a measure of last resort and that there have been many overprescriptions in the past. But Tennant believes that the government and media have gone very far in demonizing opioids, stating that it was legitimate patients who suffer most from this kind of scrutiny.

Soon the DEA started investigating Dr. Tennant, and on 15th November 2017 raided his offices and homes while he was away after being an expert witness in a trial where another doctor was facing charges of illegal prescription of opioids. The DEA accused Dr. Tenant of being a member of a drug trafficking organization and benefiting from the illegal diversion of controlled substances. During the raid, DEA agents confiscated several financial documents and patients’ records.

The raid on Dr. Tennant’s residence and offices was in the context of the crackdown on using opioids to treat chronic pain, which proponents believe to increase suffering, and in some cases, lead to suicide. Since 2016 when the CDC issued guidelines for prescribing opioids, several patients have reported being forced to cease taking opioids or cut down their usage even if higher doses provide a more effective treatment plan. Although these guidelines were not meant as rigid directives, several physicians feared being prosecuted if they failed to comply. The raid on Tennant’s premises seems to have affirmed that those fears were justified.

The federal law only allows the prescription of opioids under the grounds of legitimate medical reasons by a licensed physician in the normal course of professional practice. However, it is not the DEA, but rather doctors who determine what are the medically acceptable reasons for prescribing opioids. The only time when practitioners should be charged with drug dealing is if they are trading drugs for sex or selling drug prescriptions for profit –not for providing prescriptions that law enforcement agencies do not agree with because they are not familiar with concepts such as genetic variation and tolerance.…

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Who is Forest Tennant?

Forest Tennant, DrPH, MD, is an addictionist and internist who has spent most of his medical career treating and researching intractable pain. Between 1975 and 2018, Forest Tenant was in charge of the Veract Intractable Pain Clinics — a California-based clinic that initially specialized in post-polio disease and intractable pain. Dr. Tenant was also the editor-in-chief of the journal “Practical Pain Management” between 2007 and 2017. He still holds an Emeritus honor with the Practical Pain Management journal. Presently, Dr. Tennant runs the Tennant Foundation and its Arachnoiditis Education and Research Project. He is a member of the American Society of Addiction Medicine, the American Pain Society, the Academy of Interactive Pain Management, and the American Academy of Pain Medicine. Dr. Tenant has authored over a hundred publications on PubMed and was awarded the lifetime achievement for his work and research on patients that are very challenging to treat. In total, Dr. Tennant has written more than three hundred scientific articles and books. He also helped draft California’s Bill of Rights for Pain Patients. He has also been a Medical Officer in the Public Health Service and the United States Army and was a consultant for the Nascar, LALodgers, Drug Enforcement Administration, FDA, and the National Institute on Drug Abuse. Dr. Tennant served as the Mayor for West Covina from 1980 to 1988. In addition, he was also in charge of most of the pioneering methadone clinics treating heroin.

Since Dr. Tennant started running the Veract Intractable Pain Clinic in the 1970s when he predominantly focused on treating patients with pain caused by polio or cancer, he has never been known to shy away from the spotlight. During Dr. Tennant’s career, pain patients from across the US have been flocking to West Covina, California to see the boundary-pushing doctor since they are unable to get assistance in the states they reside in. When the “opioid epidemic” started to grow in the United States has led to a crackdown on pill mills by law enforcement agencies, consequently arresting several physicians. In 2016, the DEA targeted pain killers, clamping down the allowed opioid medication production by approximately twenty-five percent. The CDC provided a guideline advising against the prescription of high doses of opioids which can cause serious harm when combined with anti-anxiety medication or alcohol. Some pharmaceutical manufacturers were even sued by some states for prescribing high doses of opioids. However, most doctors only prescribe the drug as a measure of last resort.

Dr. Forest was a vocal opponent of this regulatory backlash since it prevented patients in chronic pain from accessing the drugs necessary to alleviate their suffering. He refused to cease prescribing the drugs to pain patients. Some people have criticized Dr. Tennant’s unorthodox methods and unapologetic style. His patients, however, continue to hold him in high regard saying that he is one of the few physicians in the United States that put their patients’ needs first.…

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