by Myra Christopher, PAINS Director

Myra Christopher, PAINS Director

On Tuesday after Thanksgiving, Senator Claire McCaskill (MO-D) led a roundtable to discuss her interest in repealing the Ensuring Patient Access and Effective Drug Enforcement Act of 2016.  It included three participants:

  • Joseph Rannazzisi, former head of the DEA Office of Diversion Control
  • Frank Younker, former DEA Diversion Group Supervisor
  • Jonathan Novak, former DEA enforcement attorney

The entire discussion focused on strengthening the power of the Drug Enforcement Administration to issue orders to revoke or suspend registrations for opioid distributors. The discussion was broadcast live on the internet, and I listened in, as I am sure did some of PAINS Update readers. However, those who saw the CBS 60 Minutes segment featuring Mr. Rannazzisi a few weeks before know what was discussed. Mr. Rannazzisi and his colleagues argued that the Ensuring Patient Access bill had hamstrung DEA and limited their ability to compel drug distribution companies to fulfill their obligation to monitor, investigate and report suspicious orders for controlled substances. Frank Younker said, “This bill tore the heart out of the enforcement program and reduced morale at the DEA to an all time low.”

In 2016, the Ensuring Patient Access bill to “improve enforcement efforts related to prescription drug diversion and abuse” AND not create obstacles to patients in need of pain medications passed with the endorsement of the DEA. The bill can be read in its entirety at  The crux of the bill, as I read it, established a higher standard of proof in DEA procedures before revoking or suspending registrations for opioid distributors under the Controlled Substances Act.

The meeting began with Senator McCaskill, a former county prosecutor, saying, “This legislation (Ensuring Patient Access) was clearly not helpful in terms of removing a valuable tool that was a deterrent….a deterrent to some of the largest companies in America that there were serious and significant consequences if they didn’t do it by the book. When you remove that deterrent, then things get even sloppier, and when things get sloppy in the area of opioids, people die. Innocent people die….”

I have worked with the DEA and met Mr. Rannazzi several times. As a constituent of Senator McCaskill, when I learned of the roundtable, I contacted Senator McCaskill’s office and asked that they consider having a patient and/or a pain care provider on the panel to discuss the challenges legitimate pain patients and providers have in accessing medications when a drug distribution company is shut down. This problem is especially challenging when one of the “big three” distributors among the total of 13 companies is involved. Several qualified people who could talk about this side of the problem were recommended with an accompanying offer to facilitate their participation. Ultimately, we were told that Senator McCaskill had decided to keep the discussion to the three former DEA staff she had originally invited.

I encourage our readers to watch the entire event and then share with Senator McCaskill and her staff the challenges you or your patients are experiencing in accessing needed treatment. As we shared stories with her staff about the consumer calls we frequently receive, her staff member said, “We just don’t hear those kinds of stories.”

In my view, there are no bad actors here. There are people, however, I believe looking at the opioid crisis in this country and not considering the unintended consequences of their actions to reduce the supply of prescription pain medications being distributed to those patients who are dependent upon them, especially at a time when many pain patients have little access to anything else.

PAINS advocates for comprehensive chronic pain care which may or may not include prescription pain medications. Tragically, very few people can access comprehensive or integrative pain care, and when they can, most often, they have to pay for it out of pocket.

Senator McCaskill has said that she intends to hold another roundtable. Let’s encourage her and her staff to include those people for whom these medications are intended to benefit and those who care for them so that she and other policy makers can fully grasp the complexity of their policy decisions.