Burn the Candle at Both Ends

A Decentralized Plan to Challenge Contracts for Legal Access to Medicine

By Kenneth L. Vice

I am challenging Oklahoma’s requirement that patients enter agreements in exchange for continued legal access to certain prescribed medicines. My position is direct:

No patient should be required to enter a behavioral contract as the price of lawful medical care.

A physician may explain risks, establish a treatment plan, monitor a patient, exercise medical judgment, and decline to prescribe. Those are professional medical acts. Requiring the patient to sign a continuing contract under threat of losing medicine is something different. It turns informed consent into compelled compliance.

But I am not asking people to join an organization, endorse me, sign one national petition, or place themselves under one leader. I am suggesting that every person affected by this system act in their own name, using their own facts, before the authorities governing them.

One petition containing thousands of names can be received, counted and answered as one organized demand. Thousands of people independently presenting thousands of actual experiences create something different: a distributed public record that cannot honestly be reduced to one advocate’s opinion.

The purpose is not to harass public employees or obstruct government operations. The purpose is to require the institutions exercising authority over lawful medicine to hear directly from the people experiencing the consequences. I assure you this way you will be heard without having to get 999,999 other people to understand and agree with you.

The outcome I want

I want state legislators to hear enough credible accounts from their own constituents that they turn toward the Drug Enforcement Administration and say:

What is being done under this system and what medical institutions are doing in response to it is giving cause for serious strife among the people we represent.

I want each DEA field division and national Diversion officials to receive enough direct, factual communications that they cannot say they have not heard from patients. The numbers do not matter. Their phones do not typically ring. They are honest… They will remember you as honest. You do not want them to remember you as angry.

The desired response is simple:

We have heard.

That acknowledgment does not itself change a law. It does something necessary before laws change: it eliminates the fiction that nobody has informed the responsible institutions. It gives legislators and the DEA a shared reason to act on our behalf.

Why the candle must be burned at both ends

The control of lawful medicine does not exist entirely at the state level or entirely at the federal level.

States enact prescribing laws, regulate medical professionals, establish professional boards, operate prescription monitoring systems and determine whether state law requires patient provider agreements. State legislatures are the bodies capable of repealing state statutory requirements.

DEA administers and enforces federal controlled substance law. Its Diversion Control Division says its mission is to prevent controlled pharmaceuticals from being diverted while also ensuring an adequate and uninterrupted supply for legitimate medical, commercial and scientific needs.

The resulting medical environment exists between those authorities. State officials may point toward federal enforcement pressure. Federal officials may answer that patient contracts and medical practice rules are state or private matters. Clinics may point toward both.

That division of responsibility becomes a shield:

• The clinic says it has no choice.
• The state says federal pressure makes restrictions necessary.
• DEA says it did not enact the state law or write the clinic contract.
• The patient is left governed by the combined result.

Squeezing only one end permits the other end to absorb the pressure.

The patient must therefore address both:

The state must answer for the law or medical rule it created. DEA must answer for the federal enforcement environment over which it exercises authority.

The objective is not to make a legally unsupported accusation that the DEA personally wrote every pain contract. The objective is to require a truthful accounting of how federal controlled substance enforcement, state law and institutional fear interact and who has authority to change each part.

Not a movement: a method

I am not proposing that everyone deliver an identical script. I am not proposing coordinated repeat calling, a campaign to overwhelm switchboards, or the misuse of government complaint systems.

I am proposing a method of independent self-representation:

One person. One genuine experience. One documented inquiry. One request for an answer.

Every participant should speak only for themselves. Every factual statement should be accurate. Every communication should concern a real law, contract, denial, restriction or consequence that affected that individual.

The strength of the method is not volume detached from substance. It is the multiplication of substance.

Three thousand identical form messages can be classified as one campaign. Three thousand individually documented accounts present three thousand people, medical histories, contracts, jurisdictions, legislators and unanswered questions.

The system should be required to confront the human consequences at the same individual scale at which those consequences occur.

The nationwide plan

The following process can be adapted by anyone in the United States. The exact legal target will differ because some states mandate agreements, some encourage them through board rules or guidelines, and some leave them entirely to clinics, insurers or hospital systems.

The national principle remains the same:

No contracts in exchange for legal access to medicine.

Step 1: Determine who actually requires the contract

Do not begin by assuming the DEA, your state or your doctor legally requires every provision placed before you.

Obtain the complete agreement and ask the provider in writing:

Please identify which provisions of this agreement are expressly required by federal law, which are required by state statute or administrative rule, and which are discretionary policies created by this practice or health system.

Then investigate four possible sources:

1. State statute: Has the legislature expressly required an agreement?
2. Administrative rule or licensing policy: Has a medical, pharmacy or nursing board required or encouraged it?
3. Insurer or health-system policy: Is payment or institutional credentialing being conditioned upon it?
4. Private clinic policy: Did the clinic create the agreement on its own?

This distinction determines what you ask your representatives to do.

Where state law requires contracts, request repeal.

Where a licensing board requires them, request repeal of the rule and legislation prohibiting replacement rules.

Where the contract is a private institutional practice, request legislation preventing medicine from being conditioned on a behavioral agreement.

Where federal law is being cited, ask the DEA to identify the exact statute, regulation or written policy establishing that requirement.

Step 2: Find the DEA field division governing your location

The DEA currently organizes its domestic operations through 23 field divisions encompassing 241 domestic offices. Its official division directory identifies the division and offices serving each region.

The Seeds of Vice division page for your location should serve as your starting map. It should help you identify:

• The DEA field division covering your state or region.
• The division headquarters.
• Resident, district and post-of-duty offices.
• The Special Agent in Charge and other publicly identified personnel.
• Available Diversion contacts.
• Main telephone numbers and official contact channels.
• The division’s geographic responsibility.
• Documented prescribing and enforcement history relevant to the region.
• Conflicts or gaps in official public information.

The regional DEA field division and the national Diversion Control Division are not the same institution. The field division is the local jurisdictional point of contact. National policy interpretations ordinarily belong to DEA’s Diversion Control Division and its Liaison and Policy Section.

That distinction should appear in every communication. Do not attribute national policy solely to a local field official. Ask the local division what it knows, what it does, what it has observed and where it forwards policy concerns.

Step 3: Identify every relevant representative

At minimum, identify:

• Your state representative.
• Your state senator.
• Your governor.
• Your United States representative.
• Both United States senators.

The federal government’s official USAGov directory provides routes for locating federal, state and local elected officials.

Your state legislators matter because they can introduce, amend and vote upon state law. Your congressional delegation matters because Congress oversees federal law, appropriations, executive agencies and the Department of Justice.

Do not write to fifty legislators as though they all represent you. Begin with the people who actually represent your address. A constituent with a documented problem normally has greater standing in a legislative office than a person sending a generic national message.

Step 4: Build your personal record

Before calling anyone, create a factual case file.

Include:

• Your city, county and state.
• The names of the state and federal districts in which you live.
• The medicine or category of medicine involved.
• The date the contract was presented.
• A complete copy of the contract.
• The clauses to which you object.
• What treatment was conditioned upon signing.
• What happened when you questioned or refused it.
• Whether the provider claimed that state or federal law required it.
• The practical medical consequences.
• Correspondence from the provider.
• A brief timeline.

Do not exaggerate. Do not call something a federal requirement unless an official source establishes that it is one. Do not publicly release private medical records merely to prove that you possess them.

Your first summary should fit on one page. Supporting documents can be provided when requested.

Step 5: Contact your state legislators

Make one clear initial telephone call and follow it with a written communication. A telephone conversation creates awareness; a letter or email creates a more durable record.

The call can be adapted as follows:

My name is [name], and I live in [city and legislative district]. I was required to sign a patient provider or controlled substance agreement as a condition of continued access to legally prescribed medicine. I am asking Senator/Representative [name] to determine whether this requirement comes from state law, administrative policy or private practice, and to support legislation prohibiting contracts as a condition of lawful medical care. I am also asking the legislator to send a formal inquiry to the DEA field division serving our state concerning the effect federal controlled substance enforcement is having on medical access. I will send a written account and supporting documents.

Your written request should ask the legislator to take specific actions:

1. Identify every state law and rule authorizing or requiring the contract.
2. Introduce or support legislation repealing those requirements.
3. Prohibit substantially similar contracts from being recreated under another name.
4. Preserve individualized medical judgment and ordinary safety monitoring.
5. Ask the local DEA field division whether DEA requires, recommends or rewards such agreements.
6. Ask DEA how it evaluates reports that enforcement pressure is contributing to disrupted legitimate medical care.
7. Provide you with the legislator’s written position.

The request to contact DEA is essential. You are not only asking your legislator to alter state law. You are asking that official to carry constituent experience upward into the federal system.

Step 6: Contact the DEA field division

Use the Seeds of Vice page and the official DEA division page to locate the division headquarters and appropriate contact.

Call the main office once. Be calm and precise:

I am a resident of [state] calling about the effect of controlled substance enforcement and diversion policy on lawful patient care. I am not reporting a crime, seeking registration assistance or requesting personal medical advice. I would like the correct contact for written questions concerning Diversion policy and its local effects.

Ask for:

• The local Diversion office or Diversion Program contact.
• A Diversion Outreach Coordinator, where one is publicly designated.
• The proper email or mailing address for a written policy inquiry.
• Confirmation of whether the matter should also be directed to DEA headquarters.

Some division pages provide only a main number; others publish dedicated Diversion contacts. The available structure is not uniform. For example, some official division pages expressly list Diversion outreach or registration contacts, while others chiefly identify headquarters and general division offices.

Do not use crime tip lines to submit a policy disagreement. Do not imply that a crime occurred unless you possess a genuine basis for reporting one.

Step 7: Put the DEA questions in writing

The DEA’s official contact guidance says policy questions should be submitted in writing to the Diversion Control Division’s Liaison and Policy Section. It also publishes national Diversion contact information.

Send the inquiry to the local field division and, where appropriate, copy the national Liaison and Policy Section.

Ask questions that can be answered with law, policy or fact:

Does any federal statute, regulation, DEA order or published DEA policy require patients receiving long term controlled medication to execute pain management, opioid treatment or patient provider agreements?

Does the DEA recommend that registrants condition prescribing on a patient’s acceptance of behavioral contracts?

Does the DEA consider refusal to sign a contract evidence that a prescription lacks a legitimate medical purpose?

Has this field division communicated formal or informal expectations concerning patient contracts to physicians, pharmacies, hospitals, insurers or state agencies?

How does DEA evaluate reports that registrants are discontinuing medically indicated treatment because they fear investigation or loss of registration?

What process does this division use to elevate patient reports concerning interference with the adequate and uninterrupted supply of controlled medicine for legitimate medical needs?

Will the division provide a written statement that patients and state legislators may rely upon when determining whether these contracts are federally required?

Do not demand that a receptionist decide national policy. Ask the office to identify the responsible official and route the written inquiry appropriately.

Step 8: Connect both sides

This is where the candle begins burning at both ends.

Send your legislators a copy of your DEA inquiry.

Inform the DEA that you have asked your elected representatives to examine the same issue.

When the DEA responds, send the response to your legislators.

When a legislator responds, send the relevant portion to DEA and ask whether the legislator’s understanding of federal authority is accurate.

The objective is to prevent separate institutions from giving incompatible explanations in private.

You are trying to create a visible exchange:

The patient says to the state: “This happened to me.”

The patient says to DEA: “Your authority is being cited as a cause.”

The legislator says to DEA: “Our constituents report that this system is producing conflict and loss of care.”

DEA must then say either: “That is our policy,” “That is not our policy,” or “We will examine it.”

Every answer clarifies responsibility.

Step 9: Request concrete legislative action

The language must be adapted to the law of each state, but the core provision should accomplish three things.

First, it should prohibit government entities and medical institutions from conditioning lawful prescribing, dispensing, administration, insurance coverage or payment on execution of a behavioral contract.

Second, it should prevent evasion through renamed instruments such as:

• Pain management agreements.
• Opioid treatment agreements.
• Controlled substance agreements.
• Patient provider agreements.
• Medication compliance agreements.
• Behavioral covenants.
• Substantially similar documents.

Third, it should preserve legitimate professional authority:

Nothing in the proposed law should compel a practitioner to prescribe a particular medicine or prevent individualized medical decisions based on documented clinical considerations.

The law should place responsibility where it belongs:

The professional documents. The patient gives or refuses informed consent. The patient is not placed under contract.

Step 10: Follow up without harassing anyone

Give offices a reasonable opportunity to respond. Follow up in writing after approximately two to four weeks if no response has arrived.

Maintain a log containing:

• Date and time.
• Office contacted.
• Person spoken to.
• Method of contact.
• Questions submitted.
• Documents provided.
• Reference or case number.
• Response deadline, if one was given.
• Answer received.
• Next lawful action.

Do not repeatedly call the same employee in one day. Do not threaten, insult or attempt to intimidate staff. Do not interfere with emergency communications. Do not manufacture complaints.

Persistence means maintaining the inquiry until it is answered or expressly declined. It does not mean making yourself impossible to serve.

Step 11: Preserve and publish the record

After removing unnecessary private information, publish:

• The exact question sent.
• The date it was sent.
• The office that received it.
• The exact answer.
• Any conflicting answers from other authorities.
• Whether the office did not respond.
• What can and cannot reasonably be concluded.

Do not silently resolve contradictions. If a legislator says the DEA requires something and the DEA says it does not, that conflict is itself a public finding.

A disciplined record has more value than an accusation.

Using ChatGPT to execute the plan

ChatGPT can help a person research their state, organize records, identify jurisdictional questions and produce individualized correspondence. It should not be treated as the final legal authority.

OpenAI advises users to treat ChatGPT output as a first draft, verify important information and check quotes, data and references against reliable sources. Search and deep research tools can gather current sources and produce cited reports, but the underlying sources should still be examined.

A person can open ChatGPT and use the following adaptable prompt.

Master prompt

I am conducting a lawful, peaceful and non-harassing civic inquiry concerning contracts imposed as a condition of legal access to prescribed medicine.

I live in [CITY, COUNTY, STATE, ZIP CODE].

The Seeds of Vice DEA field-division page covering my location is [PASTE PAGE OR LINK].

My situation is: [DESCRIBE WHAT HAPPENED FACTUALLY].

The contract or disputed provisions are: [PASTE TEXT OR UPLOAD DOCUMENT].

Research this using current official sources. Prioritize my state legislature, state statutes, administrative code, medical and pharmacy boards, the official DEA website, the Federal Register, Congress and other primary government sources.

Do not assume that DEA, my state or my provider legally requires the contract. Determine separately:

1. Whether my state mandates a patient provider or controlled substance agreement.
2. Whether a state licensing board requires or recommends one.
3. Whether federal law or published DEA policy requires one.
4. Which terms appear to be private clinic, health-system or insurer policies.
5. Which DEA field division and local offices cover my location.
6. Who my current state representative, state senator, U.S. representative and U.S. senators are.
7. Which officials have authority to change each part of the system.

Produce:

• A source cited authority map.
• A one page factual summary of my experience.
• A concise telephone script for my state representative and senator.
• An individualized written request for state legislation prohibiting contracts as a condition of lawful access to medicine.
• A separate written inquiry to my DEA field division.
• A separate national policy inquiry to the DEA’s Diversion Control Division.
• Ten precise questions that require officials to distinguish state law, federal law and private policy.
• A follow up schedule and contact log.

Do not fabricate laws, quotations, names, titles, email addresses or contact information. Mark anything that cannot be verified. Do not accuse anyone of a crime or misconduct without evidence. Do not recommend repeated calling, threats, disruption, impersonation or use of emergency or crime reporting channels for policy advocacy. Preserve my individual voice rather than turning this into a generic form letter.

After ChatGPT produces the material, verify:

• Every official’s current name and district.
• Every statutory quotation.
• Every address, telephone number and email.
• Every claim attributed to DEA.
• The current version and effective date of every law.
• Whether proposed legislation is already pending.

Then rewrite the correspondence in your own words. The communication should sound like a person describing what happened not a machine or organization manufacturing identical submissions.

What this method is intended to accomplish

This plan may not produce immediate repeal. Its first purpose is to end institutional deniability.

A state representative should no longer be able to say:

“Nobody in my district has raised this.”

A DEA field division should no longer be able to say:

“We have not heard that our enforcement environment is affecting legitimate patients.”

A clinic should no longer be able to say:

“The government requires every provision,” without being asked to identify the law.

A state should no longer be able to invoke federal authority without placing that claim before the federal authority itself.

The method does not require a national headquarters, membership dues, permission, a charismatic leader or a petition threshold. It requires individuals willing to understand the authority governing them and require an answer from it.

I am beginning with Oklahoma because Oklahoma is where I live and where I have standing as a resident. My specific objective is to end contracts imposed in exchange for legal access to medicine.

Someone in another state should not wait for Oklahoma, follow me personally or place their rights in my hands. Neither should anyone in Oklahoma even though we should all encourage each other and help each other when and where we can.

We should find the DEA field division governing our homes, identify our own representatives, document our own experience and act in our own name.

Do not gather everyone into one body that can be counted once, answered once and ignored once. Give every person the knowledge necessary to stand before the system as themselves.

Burn the candle at both ends.

Make the state hear.

Make the DEA hear.

Then make them answer each other.