Welcome to Spodek Law Group. Our goal is to give you the reality of pain clinic prosecutions - not the sanitized version other attorneys present, not the reassuring fiction that good intentions protect you, but the actual truth about what happens when the DEA decides your prescription patterns look suspicious.
Heres the thing most pain management doctors dont understand until federal agents are executing a search warrant at their clinic: the very records you kept to protect your patients are the records that will be used to destroy you. Every prescription you wrote. Every patient you saw. Every controlled substance you dispensed in good faith - its all sitting in a database right now, and prosecutors know how to make it look like drug trafficking.
This isnt about whether you ran a pill mill. This is about whether your legitimate medical practice can be made to LOOK like a pill mill on paper. And thats a much lower bar than you think.
What Pain Clinic Doctors Dont Understand Until Its Too Late
The fundamental problem with pain clinic prosecution isnt that prosecutors go after bad doctors. Its that the legal framework makes treating chronic pain aggressively look identical to illegal drug distribution. Your prescription database printout doesnt show the patient who finally got relief after years of suffering. It shows "high-volume opioid prescriber" and prosecutors know exactly how to present that.
Consider what the government sees when they pull your PDMP records. They dont see Mrs. Johnson who can finally play with her grandchildren because you found the right medication combination. They see a prescriber writing Schedule II controlled substances at rates above the statistical norm. They see patterns. And patterns are what they prosecute.
The DEA doesnt need to prove you were running a pill mill. They need to prove your prescribing wasnt for a "legitimate medical purpose" in the "usual course of professional practice." Sound reasonable? Its deliberately vague. And that vagueness is the trap.
What exactly does "usual course of professional practice" mean? Thats the point - nobody knows until a jury decides. Federal prosecutors have argued that exceeding CDC opioid guidelines proves prescribing outside the usual course. Defense experts counter that guidelines arent law and chronic pain often requires higher doses. Both positions are arguable. But only one of you has unlimited resources and years to prepare.
The asymetry is devastating. The government spends months building a case against you. They review every prescription. They interview pharmacy staff. They send undercover agents. They compile statistics showing your prescribing "outlier" status. All before you know your under investigation.
By the time you learn about it - usually when agents arrive with a search warrant - the government has already built their narrative. Your patients are "drug seekers." Your practice is a "pill mill." Your prescriptions are "distribution." Every piece of evidence that proves your legitimate medical practice will be reframed to prove criminal intent.
CRITICAL: The standard isnt whether your prescribing WAS legitimate. Its whether prosecutors can convince a jury it LOOKED illegitimate. Big difference.
How Your Own Prescription Records Become the Governments Weapon
Your medical records. Your patient charts. Your prescrption history. You created all of this documentation to provide good care and protect yourself from malpractice claims. But in a federal pain clinic prosecution, this same documentation becomes Exhibit A through Exhibit Z.
Heres were it gets perverse. The more thorough your documentation, the more ammunition prosecutors have. Every patient note, every medication adjustment, every refill you authorized - its all discoverable. And prosecutors have become experts at taking legitimate medical care and reframing it as "distribution patterns consistent with drug trafficking."
Todd Spodek has seen this playbook dozens of times. The goverment pulls your PDMP records. They identify your highest-volume patients. They cherry-pick the cases that look the worst out of context. Then they present that to a grand jury who has never treated a chronic pain patient and has no idea what legitimate pain management actualy looks like.
The "Holy Trinity" is a perfect example. Opioid plus benzodiazepine plus muscle relaxant. The DEA has decided this combination is inherently suspicious. But ask any pain specialist - this combination is often medicaly necessary for certain conditions. Doesnt matter. The DEA created there own medical standards, and now your legitimate prescribing triggers automatic red flags.
OK so lets talk about the cash practice problem. Insurance reimbursement for pain management is deliberately inadequate. Many practices go cash-only just to survive financialy. But cash practice equals immediate DEA suspicion. The system forces doctors into the very behavior it then criminalizes. Notice the pattern?
The DEA Investigation Nobody Warned You About
Most pain clinic doctors think an investigation means someone shows up and asks questions. Thats not how it works. DEA investigations run for months or even years before you know theyre happening. Think about that for a second. While your treating patients, building your practice, going home to your family - agents are building a case designed to send you to prison.
Undercover agents pose as patients. They record conversations. They document your examination techniques. They note whether you performed a physical exam, how long you spent with them, what questions you asked about there pain history. All of this becomes evidence - but you had no idea you were being investigated.
The undercover visits are designed to make you look bad. Agents complain of vague symptoms. They request specific medications by name. They express reluctance to try non-opioid alternatives. Then prosecutors point to these visits as evidence you didnt do a proper evaluation. See how this works? They create the scenario they want to prosecute.
Pharmacies are also providing information. When pharmacists flag suspicious patterns - even patterns that are perfectly legitimate for a pain management practice - those flags go to the DEA. Your local pharmacy might be cooperating with federal investigators without your knowledge. The same pharmacist you see every week could be documenting your prescribing for the government.
Patient interviews happen too. The DEA tracks down former patients. Some have overdosed. Some have diverted medications. Some are just desperate to avoid their own legal troubles and will say whatever investigators want to hear. These patients become government witnesses, and their testimony will be used to prove you knew your prescriptions were being abused.
Then comes the raid. And during that raid, DEA agents will pressure you to surrender your registration on the spot. This is a trap. Do not surrender your DEA registration during a raid. Surrendering eliminates your leverage and destroys your ability to practice while defending yourself. The prosecution continues anyway - you just gave away your only bargaining chip.
Heres the part nobody talks about: the DEA can suspend your registration administrativley. No trial. No jury. No appeal until after the suspension. This isnt a criminal proceding - its an administrative action. And it happens before your ever charged with a crime.
At Spodek Law Group, we've seen doctors lose everything before their criminal case even begins. Practice closed. Patients abandoned. Income gone. Then the criminal charges come, and you cant afford adequate defense because you havent been able to work for a year.
The multi-front attack is intentional. DEA investigation. State medical board investigation. Hospital privilege review. Insurance network termination. Each of these feeds the others. Information from your "confidential" board investigation ends up in federal prosecutors hands. The hospital that revoked your privileges becomes a witness against you.
What the Ruan Supreme Court Decision Actualy Means For Your Defense
In 2022, the Supreme Court ruled unanimously in Ruan v. United States that prosecutors must prove a doctor KNEW their conduct was improper. This sounds like a major win for pain doctors. And it is - sort of.
Heres the reality check. The Ruan decision means good faith is a defense. But claiming good faith isnt enough. You have to prove it. And the way you prove it is through documentation - the same documentation prosecutors are already using against you.
The question isnt whether you had good intentions. The question is what evidence exists to prove you knew your prescriptions were for legitimate medical purposes when you wrote them. Did you document your reasoning? Did you address red flags in the medical record? Did you follow your own controlled substance protocols?
Before Ruan, some courts let prosecutors get away with a purely objective standard - if prescribing LOOKED wrong, you were guilty regardless of what you believed. The Supreme Court rejected that approach. Now the government has to prove subjective knowledge that your conduct was unauthorized.
But heres what prosecutors do with Ruan: they use circumstantial evidence to prove you "must have known." When you recieved a PDMP alert and prescribed anyway? Evidence you knew. When your own clinic policy said maximum 90 MME and you prescribed 120 MME? Evidence you knew. When a pharmacist called about concerns and you authorized the refill anyway? Evidence you knew.
If you ignored PDMP warnings, if you didnt document why you prescribed what you prescribed, if you wrote scripts that violated your own clinic policies - prosecutors will argue you knew your prescribing was improper. The burden shifts to you to prove otherwise.
Think about that. In normal criminal cases, prosecutors have to prove you did something wrong. In pain clinic prosecutions, you have to prove you did something right. Thats the inversion. Thats the trap.
Read that again if you need to. The entire structure of these prosecutions puts the burden on you to prove your innocence. Ruan helped, but it didnt eliminate the fundamental problem: documentation gaps become evidence of guilty knowledge.
Conviction rates for prosecuted prescribers run 68-69%. That means once your charged, the government wins more than two-thirds of the time. They dont bring cases they expect to lose. By the time you see an indictment, theyve already decided your guilty - the trial is just ceremony. Sound familiar?
And remeber - even if you beat the criminal charges, the collateral damage is already done. Your practice is closed. Your license is suspended. Your reputation is destroyed. Your patients have been scattered to other providers or, worse, to the streets. The prosecution IS the punishment, whether you win or loose.
The Domino Effect: From Investigation to Destruction
Let me show you what destruction actualy looks like. Not in theory. In practice.
A doctor treats chronic pain patients legitimatly for years. Good documentation. Genuine medical necessity. But high volume - because chronic pain patients need ongoing care. The PDMP algorithm flags this doctor as a "high-volume prescriber." Not because anything was wrong. Becuase of statistics.
DEA opens an investigation. Undercover agents visit. Records get subpoenaed. Six months later, federal agents raid the clinic. Doctor is pressured to surrender DEA registration. She refuses - one smart decision.
But the practice is done. Patients scattered. Staff laid off. Income zero.
State medical board suspends license pending investigation. Hospital revokes privileges. Insurance companies terminate network participation. Bank forecloses on the medical building.
Criminal charges filed. Legal fees mounting. No income to pay them.
Even if she wins the criminal case - even if the jury sees through the prosecutions framing - the victory is pyrrhic. Career destroyed. Finances ruined. Reputation demolished. Family stressed to breaking. And she won.
Dr. Shelinder Aggarwal was the highest Medicare opioid prescriber in the United States in 2012. Fifteen years in federal prison. Dr. Jeanne Germeil - 17.5 years. She was so desperate she fled to Haiti to avoid sentencing. They caught her anyway.
The ARPO Strike Force has charged over 115 defendants responsable for 115 million controlled substance pills. They're looking for volume. Your volume. Doesnt matter if every prescription was medically justified. High volume equals presumed guilt.
CAUTION: 35-year sentences are real. Dr. Craig and Shane Faithful are serving them right now.
Fighting Back: What Works and What Destroys You
So what actually works? First, understand your fighting on multiple fronts. The criminal case is just one battle. The DEA administrative action is another. The state medical board is a third. Each requires its own strategy, and they interact in ways most doctors dont anticipate.
What Todd Spodek tells every pain clinic client: the investigation is when the case is won or lost. Not the trial. By the time charges are filed, the governments already built their case. Your defense has to start earlier.
Timing matters enormously. If you learn about an investigation early - maybe a colleague was raided, maybe you heard rumors about DEA activity in your area, maybe a patient mentioned being interviewed - thats when to get legal help. Not after the raid. Not after charges. During the investigation phase, before the government has locked in its narrative.
Documentation is your primary weapon. Not after-the-fact documentation - real-time documentation of your medical reasoning. Why did you prescribe this combination? Why did this dosage? Why did this patient need ongoing treatment? If its not in the record, it didnt happen.
Address red flags explicitly. If a patient has concerning PDMP history, document that you reviewed it and document why you prescribed anyway. If insurance sent a warning about dosage, document your medical reasoning for exceeding guidelines. The CDC guidelines arent law - but ignoring them without documentation looks like consciousness of guilt.
And please - dont create documentation after an investigation begins. Prosecutors look for this. Alterations to medical records after you knew you were being investigated are devastating to your defense. The time to document properly is now, before anything happens.
Dont surrender your DEA registration during a raid. I said this before. Im saying it again. This is the single most common mistake doctors make, and its irrecoverable. Agents will pressure you. They'll suggest it will "make things easier." It wont. It just eliminates your leverage.
Get coordinated legal representation early. A criminal defense attorney who doesnt understand DEA administrative proceedings will give you incomplete advice. A healthcare attorney who doesnt understand criminal exposure will miss the real threat. At Spodek Law Group, we coordinate across all fronts because thats what these cases require.
Consider expert witnesses. In pain clinic prosecutions, juries often have no idea what legitimate pain management looks like. Expert testimony from other pain specialists can explain why your prescribing was appropriate, why certain medication combinations are necessary, why some patients need ongoing opioid therapy. Without expert context, jurors see prescription numbers and assume the worst.
Heres were most doctors fail: they think cooperation helps. It usualy doesnt. Everything you say to investigators becomes evidence. That "informal conversation" with the DEA agent? Recorded. That "voluntary" document production? Now part of the government's case file. Exercise your rights. Get representation. Stop talking.
The worst thing you can do is try to explain yourself without an attorney present. Every doctor thinks they can talk their way out of it. Every doctor is wrong. Prosecutors have heard every explanation. They know how to twist your words. They will use your cooperation against you.
When the Government Comes For You
If your reading this at 2am because you just recieved a target letter, or because agents showed up at your clinic, or because your medical board notified you of an investigation - understand that the clock is running. The government has been preparing for months or years. You have days to respond correctly.
The first calls you make matter. Call an attorney. Not tomorrow. Tonight. The decisions you make in the first 48 hours - what you say, what you dont say, what documents you preserve, how you respond to agents - shape everyting that comes after.
Dont talk to investigators without counsel. Dont let them search without a warrant. Dont surrender anything voluntarily. Dont try to explain your medical practice to agents who have already decided your guilty. Every word you say becomes a potential exhibit at trial.
Your medical training taught you to be helpful and cooperative. Thats exactly the instinct that destroys doctors in these cases. The investigator who seems sympathetic is building a case against you. The friendly questions are designed to get you to make statements that can be used as admissions. Help your attorney help you by saying nothing.
If your under investigation but not yet charged, there may still be time to intervene. Sometimes prosecutors can be persuaded not to bring charges if presented with compelling evidence of legitimate medical practice. Sometimes plea negotiations happen early. Sometimes the right expert consultation changes the governments calculus. But none of this happens if you wait until after indictment.
The next 48 hours determine the next 20 years. Thats not hyperbole. Its the reality of pain clinic prosecution.
Call Spodek Law Group at 212-300-5196. This call costs nothing. Not making it costs everything.
You became a doctor to help people in pain. The system has decided that helping too many people makes you look like a drug dealer. Thats the trap. And you need someone who understands it to help you escape.
The government has unlimited resources. They have years to prepare. They have investigators, analysts, prosecutors, and expert witnesses. What do you have?
You have the truth of your medical practice. You have the documentation you kept. And you have the right to fight back with experienced representation.
Dont let them define you as a criminal for treating pain. Dont let the opioid crisis narrative consume your career. Fight back. Call now.
