Mon, Dec

May HMO’s Withhold Medical Treatment in Violation of AMA Ethics and CDC new Opioid Guidelines?


THE VIEW FROM HERE - How the DEA Kills Us for Fun and Profit (CityWatch, 9-4-23) explained how the DEA and FDA falsified data about Vicodin-Norco overdoses in order to aggrandize the DEA’s budget.  When there is no crisis, DEA funding drops. Thus, the DEA and the FDA use false data to mislead the public into believing that Vicodin and Norco are responsible for the increasing rate of Opioid deaths, when in reality Vicodin and Norco prescriptions either have no statistical correlation with opioid overdoses or reduce the number of overdoses.  Falsified data easily results in sensationalized propaganda. August 30, 2023, Politico, Fentanyl Is Killing Kids. State Lawmakers Are Searching for Answers, by Carmen Paun.  The DEA and FDA accomplish this fraud by including Vicodin and Norco in its data on Fentanyl overdoses.  Such deception provides the false impression that Vicodin and Narco cause overdoses even if their OD rates were zero. 

People Have Trouble Grasping How Data Fraud Operates

Suppose a high school social studies class has 30 students, four of whom engaged in smash and grab robberies. The authorities then identify by name six (6) students, the four (4) who engaged in smash and grab robberies and two (2) who never engaged in any robberies.  Then, law enforcement publicizes that this group of six students committed 10 robberies.  The two totally innocent students would be seen as criminals despite the fact they played no role in any robbery.  This is the government’s modus operandi when it comes to Vicodin and Norco; it lumps Vicodin and Norco with Fentanyl which causes the increased overdoses.  Thus, the DEA commits data fraud.

Despite the Fraudulent Reporting of Opioid Overdoses, the AMA and the CDC Guidelines Require Prescribing Vicodin-Norco

Note: The terms Vicodin and Norco (V-N) are used herein for various combinations of hydrocodone and acetaminophen because people are familiar with these labels. The main difference is that Vicodin has higher doses of acetaminophen (Tylenol, which can have serious adverse side effects.)

The AMA Ethics Guidelines https://bit.ly/45YOHxh  Four Principles of Clinical Ethics

1) Beneficence -- Treatment is to benefit the patient

2) Nonmaleficence -- Do not harm

3) Autonomy -- Patients’ values and decisions control with exceptions

4) Justice -- Distribution of scarce resources

These principles rule out HMO’s making decisions which harm the patient but financially benefit the HMO. This is particularly so when the benefit to the patient will be great (#1), the non-treatment will cause great harm (#2), the informed patient consents (#3), the financial cost to the HMO to provide the Vicodin-Norco treatment is very low and treatment available to all (#4).  The HMO, however, will face serious trouble from the government if the HMO follows the AMA Ethics Guidelines.

When it comes to prescribing low dose Vicodin-Norco for depression, all the ethics favor the prescribing.  If the HMO has any concern about harmful side effects including the patients’ increasing his dose beyond the prescribed amount, the HMO can require drug tests. When the HMO can gather real data on the patient, it may not theorize what the patient might or could do.

Nor, may the HMO claim a lack of research on the effectiveness of low dose V-N for depression. There is no evidence that low dose has any harmful impacts.   Moreover, when the patient has an established pattern of benefit from low dose V-N, the HMO may not override the benefit and patient’s autonomy due to its fear of retaliation from the government.

In 2022, Older Data on Opioids Was Superseded

“The analyses (prescriptions of V-H and Overdoses) revealed that the direct correlations (i.e., significant, positive slopes) reported by the CDC based on data from 1999 to 2010 no longer exist. Based on data from 2010 to 2019, the relationships either have reversed (i.e., significant, negative slopes) or are non-existent (i.e., no significant model).”   Frontiers | Overdose, Opioid Treatment Admissions and Prescription Opioid Pain Reliever Relationships: United States 2010-2019

Basing current medical treatment on the older CDC data is both unethical and malpractice.  Nonetheless, the DEA and FDA still promote opioid policies on known falsehoods.  The overdose data for V-N vs Fentanyl show opposite results: Fentanyl overdoses are increasing, but in some state V-N overdoses decrease, as more V-N prescriptions are written. The likely relationship is that patients with prescriptions do not buy adulterated V-N on the illicit market.  A careful reading of the CDC 2022 Guidelines, however, allows HMO’s and physicians ample room to prescribe Vicodin-Norco for both pain and as an anti-depressant.

The CDC’s 2022 Guidelines on Reducing Use of Vicodin-Norco 

The CDC is too politically astute to state the relevant data up front, but an analysis of its Guidelines shows that prescribing low dose Vicodin-Norco is not prohibited.

1)  The CDC has no absolute prohibition on prescribing Vicodin-Norco

2)  The CDC has guidelines for reducing the use of Vicodin-Norco for treatment of physical pain

3) The dose of Vicodin-Norco as an anti-depressant is substantially less than the CDC’s upper limit on prescribing Vicodin-Norco. The anti-depressant dose is between 25% and 50% of Norco dose for physical pain.

4)  There are no cases where the anti-depressant dose has resulted in an overdose

5)  There is no data that Vicodin-Norco used as anti-depressant results in the patient’s increasing his dose, e.g. depressed patient do not become habituated to V-N requiring6) The biochemistry of V-N as an anti-depressant is different from its use for physical pain.  Although the DEA and FDA do not allow any studies of V-N as an anti-depressant, studies on mice show that anti-depressant opioid binds with the mu opioid receptor, whereas other opioid receptors are involved with physical pain and with getting high.  The mu opioid receptor requires substantially less opioid than the other receptors.


Not only is it unethical and malpractice not to prescribe Vicodin-Norco as an anti-depressant, the 2022 CDC Guidelines are worded to allow the prescriptions.  An HMO which will not prescribe low dose V-N as an anti-depressant is subject to litigation by any patient who is harmed by the HMO’s policies. Class action litigation is foreseeable.


Long term use of low dose Vicodin-Norco for depression has no correlation with overdoses. When the patient has been taking the low dose Vicodin-Norco for 23 years under medical doctors’ supervision with no increase in dosage and no side effect other than constipation, withholding future low dose Norco would be medical malpractice.

(Richard Lee Abrams has been an attorney, a Realtor and community relations consultant as well as a CityWatch contributor.  You may email him at [email protected]. The opinions expressed are those of the author and not those of CityWatchLA.com.)