Author: Eli Stutsman

License Applications and Renewal Applications for Nurses and Pharmacists

If you are a practicing pharmacist or nurse in Oregon, you have already applied for a license and will periodically apply to renew your license with the Oregon Board of Pharmacy or Oregon State Board of Nursing. License applications, including license renewal applications, often ask a question similar to this question:

“In the last 3 years, have you been arrested for, charged with or cited for any crime, offense or violation of the law in any state or US jurisdiction or foreign authority?”

It is surprising how often pharmacists and nurses answer this type of question wrong.

Two common mistakes made by pharmacists and nurses

Most often, when pharmacists or nurses answer this question wrong they do so for one of two reasons, (a) because the charge or citation “for any crime, offense or violation” was dismissed, or (b) because the record was later expunged. These are good outcomes, and you are to me commended. Unfortunately, pharmacists and nurses sometimes conclude that because a charge was dismissed, the arrest was wrong, and therefore the arrest doesn’t “count.” Or, pharmacists and nurses sometimes conclude that because the conviction was later expunged, there is no record of the arrest, so arrest doesn’t count. Don’t make these mistakes.

But were you arrested?

It is necessary to read each license application or license renewal application carefully, and to answer each question accurately. The question quoted above asks, “have you been arrested . . . .” Although the charge may have been dismissed, or the conviction and underlying record may have been expunged, you were still arrested, and that fact will not change, but can most often be satisfactorily explained.

When in doubt, consult a medical licensing attorney

If you have questions about how to answer a question on your license application or license renewal application, or you doubt that your negative legal history can be satisfactorily explained to your licensing Board, you are encouraged to consult an attorney having experience working with the Oregon Board of Pharmacy or the Oregon State Board of Nursing.

Oregon Medical Board Withdraws Revocation Order on Appeal

Notice of Proposed Discipline and Request for Hearing

On September 13, 2019, the Oregon Medical Board issued a Notice of Proposed Discipline against a physician and, unfortunately, the physician missed the 21-day deadline to file her Request for Hearing.  The physician’s Request for Hearing was filed 11 days late.  The Oregon Medical Board found the physician to be in default and issued a Default Final Order refusing to grant the physician a hearing, and instead revoking the physician’s Oregon medical license (the physician was also licensed in Washington and California).

Request for Reconsideration by the Oregon Medical Board

On behalf of the physician, I petitioned the Oregon Medical Board to reconsider its revocation order, asking that the physician’s case instead be allowed to proceed to a hearing on the merits of the case. The Oregon Medical Board allowed reconsideration, but did not change its opinion.  The Oregon Medical Board instead issued a Default Final Order on Reconsideration, affirming its earlier order revoking the physician’s medical license without a hearing.

Request for Judicial Review by the Oregon Court of Appeals

I next petitioned the Oregon Court of Appeals for judicial review of the Oregon Medical Board’s Default Final Order on Reconsideration.  On December 21, 2021, I filed the physician’s opening brief in the Oregon Court of Appeals, raising the following questions:

                1.            Whether the physician’s 11-day delay in requesting a hearing should be excused due to the combination of circumstances confronting the physician, when those circumstances establish that her delay was reasonable;

                2.            Whether the Oregon Medical Board’s order revoking the physician’s medical license was legally insufficient when: (a) it was issued in the absence of a prima facie case; (b) it was not supported by substantial evidence; and (c) it was not explained by substantial reason;

                3.            Whether the Oregon Medical Board violated the Oregon Administrative Procedures Act (APA) by revoking the physician’s medical license when: (a) the kinds of allegations against the physician did not result in revocation in other cases involving similar conduct in the preceding five years, and (b) the Oregon Medical Board failed to explain this inconsistency from its previous practice; and

                4.            Whether the Oregon Medical Board deprived the physician of due process when it revoked her medical license.

The Oregon Medical Board’s Response

Less than two months later, without ever filing a response brief, the Oregon Medical Board withdrew its order revoking the physician’s medical license for further consideration.  And two months after that, the Oregon Medical Board issued its second order on reconsideration, but this time the Oregon Medical Board ordered that the physician’s case proceed to a hearing on its merits.  The hearing is scheduled for summer of 2023, more than three years after the Oregon Medical Board issued its first order revoking the physician’s medical license, an order the Oregon Medical Board chose not to defend on appeal. 

Pharmacist ponders opening medical marijuana dispensary


This might be a bad idea–for the pharmacist

In recent years, a number of states, including Oregon, have “legalized” marijuana for medical purposes (and in fewer states, for recreational use).  As reported in the Okeecheobee News, Florida voters recently approved legalization of medical marijuana and now Florida cities must decide whether to opt out.  If the Okeechobee City Council decides to allow medical marijuana dispensaries within city limits, one local pharmacist urges that he be considered to run the dispensary, but that might be a bad idea–for the pharmacist.

Florida pharmacist Steve Nelson acknowledges that “medicinal marijuana is not an easy issue,” but he is sympathetic, and he has seen the benefits of medical marijuana in treating seizures, terminal cancer, and chronic arthritis.  I don’t doubt him. Mr. Nelson is also quite experienced (40 years as a pharmacist) and appears cautious, urging the city council to be careful, to ensure adequate controls are in place.  One difficulty, according to the Okeecheobee News, is that the city would have “little power” to regulate medical marijuana because “regulation falls to [the] new state law.” It is not that simple, however.

Marijuana: a Schedule I banned substance under federal law

Despite Florida’s new state law, marijuana is still a Schedule I banned substance under the Controlled Substances Act (CSA), meaning that without a research permit or exception, marijuana cannot be possessed, prescribed, or dispensed for any purpose under federal law, and therein lies the rub.  Over the course of his 40 years experience, Mr. Nelson has practiced pharmacy with a state license as authorized in great part by a federal Registration administered by the DEA.  Now he wants to dispense marijuana contrary to the CSA’s drug schedules and DEA oversight?

Admittedly, for a number of reasons, federal law banning marijuana has been lightly enforced and, in those states where marijuana is “legal,” a lax attitude also prevails among the general public.  However, for those of us that possess a professional license, and especially healthcare providers also possessing a DEA Registration, we are held to higher standards.  In my experience, when there is a Board investigation, marijuana, medical or otherwise, is a complicating factor.  I know this to be true for Oregon physicians, whether recommending marijuana for medical use, or consuming marijuana for recreational use, and I fear my experience will prove true for Mr. Nelson should he choose to run a dispensary.  Yes, I know, Mr. Nelson’s state license and federal DEA Registration are not necessary to run a dispensary under Florida’s new law.  Still, Mr. Nelson is a state-licensed pharmacist, with two pharmacies dispensing controlled drugs as authorized by the CSA pursuant to separate DEA Registrations – does Mr. Nelson really want to run a third operation dispensing a Schedule I substance banned under the CSA?  As a lawyer, I recognize the legal distinctions and I can make the arguments to support Mr. Nelson’s goal of running a dispensary but, as a practical matter, I see the risks of unwanted scrutiny, and more.  Much more.  I earlier commented on physicians, marijuana, the new DEA, and the Oregon Medical Board and marijuana, the practice of medicine, and the Oregon Medical Board, cautioning Oregon physicians physicians not to become complacent when involved with marijuana.  I have also defended pharmacists and physicians for dispensing lawful drugs.  Given my experience, I cannot imagine recommending that a state-licensed, DEA-registered practitioner dispense a Schedule I banned substance, even if its “only” marijuana.

Drug and alcohol abuse and the licensed healthcare professional

For most people, that’s enough

Earlier this year, I needed to help a licensed health care professional obtain more treatment, so I spoke with his drug counselor, who was surprised at my inquiry.  From the drug counselor’s standpoint, my client had completed the requirements of his court-sanctioned diversion program with perfect attendance, consistently clean urine tests, and no withdrawal symptoms – so, what more was there to do?  For most people, that’s enough, and perhaps rightfully so.  But, if you’re a licensed healthcare professional, you will often be subjected to more scrutiny and more will be expected of you.

More is expected of a licensed healthcare professional

If you are licensed by the Oregon State Board of Nursing, the Oregon Board of Pharmacy, or the Oregon Medical Board, your licensing board will want to know whether your substance abuse incident (often involving a police report, arrest and conviction, or a drunk driving arrest and conviction) is an isolated incident, or part of larger problem.  If part of a larger problem, even if your practice hasn’t been affected, your licensing board may want to intervene, to gather more information, to ensure there are no public safety concerns.  If this happens to you, you need to be prepared, and this is no time to learn on the fly.

Experience gained – the truth about honesty

Two tough cases with “easy” resolutions

I have represented licensees facing allegations involving alcohol.  Two stand out favorably for lessons learned.  One had a significant alcohol history and the other a significant alcohol-related incident.  Both, however, were fully forthcoming and painfully honest when interviewed by their licensing boards, and both fully embraced and responded to their treatment.  Although both had significant issues with alcohol, the investigator, and eventually the licensing board, trusted them and their treatment.  Both licensees were treated respectfully, and both licensing boards joined in the search for solutions tailored to the individual.  Neither licensee lost much time from work, and revocation was never the issue, an optimum result for both licensees.

Three tough cases with “hard” resolutions

Two other cases stand out for lessons learned, but these were painful lessons for the licensee.  One licensee had a significant drug history, the other a significant alcohol history, but both were in denial until one was caught by testing and the other threatened with revocation of his license.  A third case stands out because the licensee had a minor alcohol history but, in the investigator’s mind, the licensee’s explanation of the incident in question was suspect.  In all three cases, the investigator did not trust the situation, which is always problematic, because investigators have resources.  In all three cases, the investigator pursued his or her suspicions until confirmed, at least in part.  These are mistakes to be avoided.

Lessons learned:

  • If you know you have an alcohol or drug problem that can be verified and warrants treatment, the sooner you accept the truth of your situation and get in front of your treatment needs, the easier it will be to maintain your medical license and restore your health.  Why wait to be caught?
  • If you have been caught, but you are forthcoming and honest about your drug or alcohol abuse, you will gain the trust of the investigator and eventually your licensing board, and your life will be easier.  Treatment and return to practice will be the goal.
  • If you have denied a known drug or alcohol problem and your explanations are suspect, you will be pursued until caught (remember, investigators have resources).  Once caught, a convincing and genuine 180 degree course-reversal will be necessary to save your medical license.

What to expect – the “balancing act”

That you may have a drug or alcohol problem alone, without more, is not enough to lose your license.  If you are a nurse, pharmacist or physician licensed by the Oregon State Board of Nursing, the Oregon Board of Pharmacy, or the Oregon Medical Board, you own your license as much as you own your car; it is your personal property, and it cannot be taken without a specified process, aka due process.  It is important to know, however, what you must concede to your licensing Board, and what you must do, to keep your license.  If you do the right things, the power to keep your license shifts to you, but if you do the wrong things, the power to revoke your license shifts to the Board.  An experienced lawyer can help you make decisions that will keep you in a defensible position.

Remarkably, even if you have received a “notice of revocation” of your license, it may not be too late.  I can think of two cases in which I was retained after a notice of revocation had issued but we were able to turn both cases around by quickly doing the right things in a genuine way (sometimes the notice of revocation is the final wake-up call).  In a third case, however, I was not able to help – the problem was inexcusable dishonesty and the board did not see any way to fix that kind of problem.

One final thought: be forthcoming with your lawyer too

I am not gullible, but I can be mislead and, unlike your investigator, I will not fact-check you except in the rare case.  As I write this, I can think of three licensees that misled me and their licensing boards, until they were caught.  I believed all three.  In two of the cases, the licensee denied a drug or alcohol problem and denial was recognized as part of the disease.  I understand that dynamic and your licensing board will too.  There will be some sympathy, so long as no further mistakes are made.  In the third case, however, no such luck. I was present with the licensee when, during a tape-recorded board interview, the licensee was confronted with evidence that disproved the licensee’s prior answers.  It was a painful moment for me, and certainly for my client, and there was no disease to blame, just dishonesty. Ouch.

The bottom line is that if you are honest, your licensing board will do much to work with you, but if your board thinks you can’t be trusted, you’ve made your situation much worse.  Finally, if saving your license is your most important objective, be honest with your lawyer too.  Your lawyer can help you to make the right decisions, present difficult problems in the best light, accept responsibility where you must, and defend the rest.

Narcotics: too many, too much, too long

Oregon Medical Board investigations and narcotic prescribing

It is my recent experience that during medical board investigations, no matter what the nature of the initial complaint, a physician’s prescribing practices will be reviewed if there is any opportunity to do so. And why not? From the Oregon Medical Board’s perspective, there is a national opioid problem, and part of that problem resides in Oregon.  As recently as July 6, 2017, this was the “good news” in Oregon:

“Anne Schuchat, the CDC’s acting director, expressed tempered optimism about the first national decline in opioid prescriptions that the CDC has reported since the crisis began in the late 1990s.

“She said the prescription rate is still triple the level it was in 1999 and four times as much as it is in some European countries.  Even at the reduced prescribing rate, she said, enough opioids were ordered in 2015 to keep every American medicated round-the-clock for three weeks.

“‘It looks a little bit better, but you really have to put that in context,’ Schuchat told the Washington Post. ‘We’re still seeing too many people get too much for too long.'”

Study: Opioid prescriptions largely drop in Oregon counties, July 6, 2017.

The problem is worse in Oregon’s rural counties:

“In Oregon, Curry County prescribers gave out the most opioids per person in 2015, followed by Baker and Malheur counties.  At the bottom of the list — Grant County.”

Study: Opioid prescriptions largely drop in Oregon counties, July 6, 2017.

It is also my experience that rural practitioners will defend their prescribing practices by expressing sympathy for their patients, and explaining that a large percentage are uninsured and there isn’t a pain specialist for miles around. Unfortunately, it is my further experience that these explanations will not get you very far with the Oregon Medical Board.  From the Oregon Medical Board’s perspective, there may be a problem, but narcotics are not the long-term solution in most cases.  If you possess a state medical license and a federal DEA Registration, the Oregon Medical Board expects you to know this, and to do your part to correct the situation.

Sympathy, combined with skepticism and alternatives

The Oregon Medical Board makes its prescribing guidelines – Oregon Opioid Prescribing Guidelines: Recommendations for the Safe Use of Opioid Medications – available on the rotating banner of its website home page, or click here.

Using sarcasm to make a final point, if you truly want to invite trouble from the Drug Enforcement Administration (DEA) or the Oregon Medical Board, treat chronic pain with narcotics in excess of 90 days and 120 MED (morphine equivalent dose), with too much sympathy by the practitioner, in an under-served rural area, with a large percentage of uninsured patients and no pain specialist within miles, which is a recipe for trouble and an invitation for a DEA or Oregon Medical Board inquiry.

Oregon Court of Appeals reverses trial court in my client’s favor – Attorney Fees

This is a case I took up on appeal for another lawyer and won. I represented the plaintiff, the Marandas Family Trust. Plaintiff owns a cabin on Mount Hood. After plaintiff hired defendants to repair the roof of the cabin, plaintiff discovered that the defendants’ repairs were faulty, and the roof had leaked rainwater causing damage inside the cabin. Plaintiff sued. In court-annexed arbitration, plaintiff won almost all the money it sought for the damage to the cabin, plus costs and disbursements, but the arbitrator denied plaintiff’s attorney fees under ORS 20.080(1).  Plaintiff filed exceptions (objections) to the arbitrator’s decision in the circuit court, which the circuit court denied. I was hired to take the appeal. This was a fight over the right to recover statutory attorney fees, and the interpretation of the applicable state statute, ORS 20.080(1). Specifically, the issue was the interpretation of a new clause, added to the statute in 2009.

The Court of Appeals’ opinion

This appeal took four years to reach decision before the Court of Appeals published its detailed opinion, ruling in my client’s favor, and reversing the arbitrator and the Circuit Court below. See Marandas Family Trust v. Pauley, 286 Or App 381 (2017). This is a important win for my client, but it is also an important opinion for the general public and the courts statewide because it interprets and explains one of the 2009 revisions to ORS 20.080(1).

Remand to the Multnomah County Circuit Court

This appeal will now be remanded (returned) to the trial court for further proceedings, to award attorney fees to plaintiff, the Marandas Family Trust.

. . . a little more about reports to the National Practitioner Data Bank (NPDB)

I recently wrote about the consequences of stipulating to a temporary restriction on your medical license.  One such consequence is a report to the National Practitioner Data Bank (NPDB).  A data bank report, like professional discipline on your license, will complicate your professional life.  All too often, however, the focus is on avoiding or mitigating professional discipline while the likelihood of a data bank report and its impact is forgotten.  Whether you are a physician, pharmacist or nurse, the preferred resolution to a Board investigation is both non-disciplinary and not report-able to the NPDB.

The National Practitioner Data Bank (NPDB) guidebooks

Whether an incident must be reported to the National Practitioner Data Bank is well beyond the scope of this writing.  The point of this writing is simply to raise awareness and to provide two NPDB resources, the 200-plus page “guidebook” for the National Practitioner Data Bank and a short summary of NPDB reporting “triggers.

Beware when consenting to a temporary restriction on your medical license

How long? – Longer than you think, plan for the “duration”

Physicians, pharmacists and nurses under Board investigation are occasionally asked to sign an Interim Stipulated Order (ISO) or Interim Consent Order (ICO) accepting a voluntary restriction on their license or, worse, suspending practice pending the outcome of the investigation.  Although it may be suggested that the voluntary temporary restriction could soon be lifted, frequently the process necessary to resolve the issue will take six to 12 months, often longer for physicians due to the complexity and risks associated with a physician’s practice and the Medical Board’s case load.

What else? – Consider the following:

  • National Practitioner Data Bank (NPDB) reports

A physician, pharmacist or nurse consenting to a restriction on his or her license will also need to manage the consequences of a report to the National Practitioner Data Bank (NPDB).  There are many events that will trigger a data bank report and consenting to a restriction on your license to practice medicine, pharmacy or nursing, is one of them.

  •  Board Certification, credentialing, and/or employment

A board certified physician consenting to a restriction on his or her medical license should assume, until it is established otherwise, that his or her board certification will be withdrawn, and that credentialing may be at risk too.  Further, some employer’s will terminate a restricted physician.  The Veterans Administration (VA), for example, requires every physician to have at least one unrestricted medical license.  While it is possible to practice with a restricted license or DEA Registration, it takes planning.

  •  DEA Registrations

A prescribing physician, physician’s assistant (PA), or nurse practitioner (NP) should also consider the impact of a restricted license on his or her DEA Registration.  Remember, in order to hold a DEA Registration, the Drug Enforcement Administration (DEA) requires every DEA Registrant to possess valid state authority to prescribe controlled substances.  Consequently, if you consent to a restriction on your prescribing privileges, or consent to voluntarily withdraw from practice pending the outcome of an investigation, you should be ready for a call from a DEA agent requesting the surrender of your DEA Registration.  Thus far I have had success convincing the DEA to await the outcome of the investigation, but nothing is certain, and you should need to plan accordingly.

Bottom line: Plan for all the consequences of a restricted medical license

If you are a physician, pharmacist or nurse under investigation and your licensing Board requests that you consent to one or more restrictions on your medical license, you need to know that the restriction will probably last more than a few months and there are numerous other consequences to consider depending upon your type of practice and level of licensure.  Each case is different and there may be more to consider than is discussed here. Diligence and planning is required to survive a restriction on your medical license.

Physicians, pharmacists, and nurses: Are you stressed by license or renewal applications?

I have written on this topic before. Ten months ago I wrote about mandatory reporting requirements and the dreaded “yes questions.” Nineteen months ago I asked whether license applications or license renewals caused a sinking feeling in the pit of your stomach and wrote about that. Today I am revisiting this topic because it is part of my practice every week. Recently, I helped a new graduate make her first license application and a seasoned professional file his license renewal application. Both had alcohol-related incidents to report and explain. Last week I also helped three nurses and two physicians that were either “caught,” or otherwise had to self-report and explain alcohol or drug activity. It should come as no surprise then that the Oregon State Board of Nursing, the Oregon Board of Pharmacy, and the Oregon Medical Board are all well experienced with substance abuse issues and arrest records. The good news is that whether you are a nursing, pharmacy, or medical student, a recent graduate, or a licensed professional, if you have a substance abuse issue or arrest record, much can often be done to help you obtain or maintain your professional license.

Forward thinking medical students have time to act before applying for licenses

One forward thinking pharmacy student and another forward thinking medical student wanted to determine before starting their educations whether their arrest records involving drugs or alcohol would preclude them from obtaining a pharmacy or medical license upon graduation. The medical student would also need a DEA Registration. One nice thing about helping students at the beginning of their educations is the element of time. I can help a student anticipate what lies ahead, and understand what he or she can do ahead of time to improve the odds of being licensed upon graduation. Much can be done to help students prepare themselves well before it is time to apply for that first license.

Recent medical graduates likely have more to help their license applications than they know

If you are about to graduate as a nurse, pharmacist, or physician, and the thought of applying for your first license causes a sinking feeling in the pit of your stomach, there is reason to be hopeful. It is my experience that whatever drug, alcohol or arrest history is in your past, there will be many positive things to stress in your favor when applying for your first license. You are a new graduate after all, so you have done a number of things right; what are they? The key to this approach, however, is that whatever drug, alcohol or arrest history is truly in your past. If, for example, you have a drug history and you are arrested for a drug violation while your license application is pending, that new drug arrest presents a much more difficult obstacle to overcome.

Help for seasoned physicians, pharmacists, and nurses when renewing

Licensed professionals must report certain drug and alcohol related activity, convictions, and some arrests and often seek help with their license renewals. If you find yourself in this situation you are not alone, and the Oregon State Board of Nursing, the Oregon Board of Pharmacy, and the Oregon Medical Board are all well experienced with drug, alcohol, and arrest records.

Recently, I helped one licensed heath care professional complete his renewal application. He had an alcohol related incident since his last renewal but he had also done everything necessary to take care of his health and return to work. His renewal application made clear that insufficient explanations and/or documentation could delay his renewal. Fortunately, he did the hard work before I became involved and my role was limited to assisting his explanation and assembling the documents I knew his licensing board would expect to see to ensure he is healthy, competent, and safe to return to work. Despite his report of a significant alcohol related incident, his renewal went through without further effort.

Some time ago, I helped an out-of-state nurse obtain her Oregon nurse’s license. Her situation was not uncommon. When she was young, she incurred a relatively minor drug and arrest record about the same time she obtained her first nursing license, so her first nursing license issued with heavy restrictions and those restrictions that were never lifted. When she called upon me to help her apply for her Oregon nurse’s license, she was emotionally beaten by the restrictions that had haunted her practice for a decade. Once we started working together, I was impressed by all that she had accomplished personally and professionally since she was first licensed. Whatever happened a decade ago was old history, no longer relevant in gauging who she is today. All that we needed to do was organize and present her accomplishments in a way that could be understood and verified by the Oregon State Board of Nursing. Her unrestricted nursing license quickly issued, with no interview and no further questions. I was happy for her and impressed by the Oregon State Board of Nursing for processing her nursing license application so expediently.

A perfect storm is brewing for physicians prescribing narcotics

Defending physicians prescribing narcotics for chronic pain has never been easy and I have long criticized the the Drug enforcement Administration (DEA) for conflating the civil standard of care with the criminal conviction standard, thereby criminalizing the practice of medicine. Sixteen months ago I commented that the DEA unnecessarily extends its investigations to the detriment of physicians and patients (DEA investigations: How much is too much?), and 11 months ago I commented that a new standard of care has emerged for the treatment of chronic pain (The pendulum has swung: Treat chronic pain cautiously). Now Attorney General Jeff Sessions, who heads the DEA, has ordered his federal prosecutors to seek the maximum punishment for federal drug offenses. All tolled, a perfect storm is brewing for physicians prescribing narcotics to treat chronic pain.

Treating chronic pain > 90 days and 120 MED (morphine equivalent dose)

With a few exceptions (e.g., cancer pain or hospice care), if you treat chronic pain with narcotics in excess of 90 days and 120 MED (morphine equivalent dose) and your prescribing practices have not evolved over the past five to seven years consistent with the emerging standard of care, you have likely failed to “keep up” and you may be at risk of regulatory intervention. If you treat chronic pain with narcotics in excess of 90 days and 120 MED, and you are not a pain specialist, or you do not refer your patients to a pain specialist, and your patients are not on taper plans, your medical practice may be a ticking time bomb

Prescribing guidelines: The emerging standard of care

The following practice guidelines, offered by the Oregon Medical Board and Oregon Health & Science University (OHSU), reflect current standard of care expectations when prescribing narcotics to treat chronic pain:

If your practice is not in line with these recent guidelines, you may be risking sanctions by your state medical board or the DEA. If your practice comes to the attention of your state medical board, your medical license may be subject to quick restriction or threatened revocation. Similarly, if your practice comes to the attention of the DEA, your DEA Registration may be subject to restriction or revocation and, in a worst case scenario, you may be subject to a criminal investigation. This already serious problem has been exacerbated by a newly invigorated DEA that has been instructed United States Attorney General Jeff Sessions to pursue the maximum punishment available for federal drug law violations.