Here is a letter from Tom Reach, MD that I received long ago but promised not to publish while he was under attack.  He finally took a plea in March, was sentenced in June, 2023, and is currently on his way to prison. So it is now okay to publish.  See his credentials and leadership in medication assisted therapy (MAT), and it is hard to understand why the government attacked him, except to go after his assets and eliminate the expendable populations he served.  With his plea, however, the government only got $150,000 in fines and forfeitures. You can read more about his plea HERE.

His letter:

Ralph Thomas Reach, M.D., ABFP, ABPM, FASAM
4654 Greenwood Drive
Jonesborough, Tennessee 37659

May 30, 2021

Advocates for opioid recovery

Dear …

My name is Tom Reach and I am a person in long term recovery from substance use disorders.  I practiced as an emergency physician for over twenty years in the coal fields of Appalachia, ground zero for the Oxycontin and opiate epidemic, and I too fell victim to the disease.   For over 19 years now I have been an active member of the recovery community, and for the past 10 years an outspoken advocate for patient’s rights, evidence-based medication assisted therapy, expansion of treatment, enforcement of parity laws, and criminal justice reform for people with addictive disorders. I served for years on the Legislative Committee of ASAM and was a Past President of the Tennessee Society of Addiction Medicine.

Allow me to share a short vignette from a letter that I wrote to Dr. Wayne Dyer some 5 years ago…

Dear Wayne,

The Universe is unfolding a miracle in Tennessee, a manifestation of energies as taught by one of my greatest teachers, namely… you.   But first, the opening paragraph of the national best seller, not quite completed…

My wife Maggy handed me the phone with a puzzled look on her face…

“ Tsome guy says he knoss chew—old friend.”  She turned her round smiling face sideways, a wry twist to her mouth.  Her grandfather was a Yaqui medicine man, and with her jet black Apache/Mexican hair cascading to the side, she always had a way of “seeing”.  In spite of her excellent English, she still sounded vaguely of Ricky Ricardo “Let me splain you, Lucy”.  She was concerned.

I stared at the phone briefly.  None of my old friends had made any effort to contact me since I dove off the deep end into needle dope in 1997, overdosed on a speedball combination of a gram of coke and 20mg of IV Dilaudid, laid out in the yard all night in the freezing cold, was coded with CPR in the ambulance, and woke up intubated in the Emergency Room where I had been working as an ER doctor just six hours earlier.   Poor form.  Put a bit of a damper on my medical career. After years of unsuccessful rehab I had took off for Mexico in 2001 after 9/11 to run drugs on the border and die.

“Guy named Billy?”

Of course—it would be Willo.  He had tracked me down after 7 years.  I took a big breath.

“Hey”.

“Reach!!!  Doctor Tommy Reach??!!”

“Yup.  Still here.”

“I thought you were dead!”

“Yeah.  I get that a lot.”

“Holy Shit!  Holy Shit!… Buddy!  You’re alive!”

“Yup”

“And you’re a doctor again?! I mean—what?  How did that happen?  You had lost your license!  The criminal charges!  You were lost—you were gone.  We had all given you up for dead.”

“Well—BillyBob, it’s a long story.”

After being out of medicine for eight years, working a vigorous program of 12 step recovery, and undergoing multiple evaluations, I got my medical license back in 2005 and then completed a family medicine residency at ETSU in Johnson City, Tennessee.  After three years working as an emergency physician, Maggie and I opened a small addiction medicine practice utilizing MAT.  Two years hence I was board certified in addiction medicine. By 2015, we had grown to twelve facilities in four states with 40 providers, over 100 employees and 2500 patients.  We had established what many consider to be the National Standard of Care for outpatient medication assisted therapy.  In our eight years of operation, we gave away over a million dollars’ worth of free medical care to those in most desperate need.

On May 2, 2018, after years of commitment to our mission, open political activism and constant harassment from the DEA, an army of over a hundred federal agents swept into our medical practices and my small farm, terrorizing my family, our patients, and staff, and seizing medical records, computers, and personal cell phones.  They disrupted thousands of people’s lives and put many patients at risk of relapse and death.  These raids were well documented and scrutinized in the national press, including Fox Business News.  I lost everything except what really mattered… my faith, my family, my true friends, and my recovery.

Now over three years later, and three failed attempts at a Grand Jury indictment, the federal prosecutor in southwest Virginia, Randy Ramseyer, has convinced a fourth Grand Jury to indict me on 42 federal charges.  I am facing hundreds of years in prison and tens of millions in fines… all for openly advocating for Medication Assisted Therapy and for evidence-based practice.

This is not just an attack on me, it is an attack on Medication Assisted Therapy and people with substance use disorders.

 

I have included a bullet point summary of our activities and attached appropriate documents…

Highlights of Our Activities at WRC

Advocacy

Working together regularly with Mike Barnes at DCBA Law and CLAAD in Washington, we produced several landmark documents advocating for medication assisted treatment, the most important of which was the petition for rulemaking to increase the number of patients allowed by DATA 2000, submitted to Secretary Sylvia Mathews Burwell on July 16, 2014. I traveled to Washington on several occasions and met with June Savilli and others at the ONDCP to advocate for action, and shortly thereafter the allowed number was increased to 275.

Additionally,

• Dr. Reach worked closely with Dr. Stephen Loyd, drug czar for Tennessee under Michael Botticelli.
• Dr. Reach was frequently in Washington, collaborating with Dr. Stuart Gitlow, Penny Mills, Susan Awad, and Dr. Kelly Clark with the American Society of Addiction Medicine lobbying and advocating for Medication Assisted Therapies.
• Our office was toured by multiple political figures, including U.S. Representative Phil Roe, State Representatives Tony Shipley, Matthew Hill, Timothy Hill, Micah Van Huss, and Bud Hulsey, and Tennessee Lt. Governor Ron Ramsey. 
• We actively lobbied the Tennessee Medicaid Program when they were taking steps to restrict reimbursement for MAT and limit buprenorphine coverage to 12 months.  The efforts ultimately resulted in a statewide Medicaid coverage of MAT.
• Dr. Reach lobbied in Washington for the final rules implementing the Mental Health Parity and Addiction Equity Act (MHPAEA)
• We formed Political Action Committees in both Virginia and Tennessee to educate and support legislators who promoted increased access to treatment for people with substance use disorders.
• We initiated discussions about the appropriate use of benzodiazepines with buprenorphine-based MAT, then wrote rules and guidelines that have been adopted by many state agencies.  These findings were recently confirmed by an FDA ruling.
• We sounded the alarm about the over prescribing of the buprenorphine monoproduct (Subutex).  Dr. Reach determined early on that this was a primary drug of abuse for IV users in Appalachia, and strongly advocated for legislation restricting its use.  We were personally responsible for passing legislation in both Tennessee and Virginia.
• We openly advocated for an Omnibus Treatment Bill in Tennessee which resulted in the passage of the Opiate Addiction Treatment Act of 2015 (Bella’s Law), most of which was written by Dr. Reach.
• Dr. Reach successfully challenged a proposed Tennessee law that would have required a Certificate of Need for every physician who prescribed buprenorphine in the State.
• Dr. Reach was appointed to the buprenorphine guidelines committee in TN and helped craft the OBOT Licensure rules and regulations for the State.
• In Virginia, Dr. Reach was appointed to the Governor’s commission and helped craft the buprenorphine guidelines and state regulations.

Best Practices

1. In 2014, Dr. Reach wrote and published Best Practice Guidelines for the Watauga Recovery Centers and proffered them to ASAM as a framework for their national guidelines.
2. We pioneered the practice of using recovering addicts as peer support specialist through our Intentional Recovery Educational Program, long before there were any state sponsored or mandated licensures available.
3. We required group attendance, held 12 step meetings in our facilities, utilized contingency management, and had our staff all trained in motivational interviewing.
4. Median staff to patient ratio of 1:8, far exceeding SAMHSA’s recommendation of 1:12 for outpatient practices.
5. We pioneered the diversion control program, including fractionated drug screening, checking arms at every visit, doing random pill counts, and as soon as prescription monitoring was available, Dr. Reach required that PMP’s were checked at every visit and advocated this statewide.
6. We functioned as a beta site for the state-of-the-art Stratus EMR, using electronic medical records for MAT long before it was required by the government.
7. We published and regularly updated a physician’s practice manual for our 1099 providers to ensure that all were practicing up to standard.
8. We had a licensed clinical pharmacist who did regular chart reviews on each provider and took corrective action when needed.

   Business Practices
   

9.  Dr. Reach established an open door and transparent business model that focused on vision, mission and excellence in patient care.
10.  We provided needs-based assistance to many of our patients and provided free services to the Washington County jail for their incarcerated pregnant women.
11. WRC was always administratively top heavy to ensure compliance with all federal and state laws.
12. Costs to patients were always kept to a minimum, and most of our small profit margin went into facilities, patient care, employee benefits, and pro bono work in the community.
13. Before there were any Federal mandates, we offered our employees a full benefit package, including top shelf health insurance where the company covered the deductible.
14. We regularly obtained expert legal advice on any rule or regulation that was in question.
15. We had a reputable accounting firm for payroll, audits and taxes.  There have been no charges for “missing money” or tax irregularities.
16. When we heard that the Department of Justice was interested in our activities, we proffered the entire company to the AUSA Randy Ramseyer three years before he initiated the unnecessary “raid” on our facilities.
17. We were moving into a full insurance model in both Virginia and Tennessee just prior to the raid.

Community/Law Enforcement

3/5/12   Presentation by Dr. Reach on substance use disorders and increasing access to MAT at the Abingdon town meeting.

5/3/12   Dr. Reach on local access TV advocating for MAT… asked to appear twice more in the following months.

5/17/12   Dr. Reach presents to the Bristol Virginia Drug Courts and Department of Social Services about MAT and increasing access to care.

6/19/12   Dr. Reach presents to Southwest Virginia Department of Child Protective Services in Abingdon, Virginia.

8/15/12   First DEA Audit… we were told by the agent that he wished everyone ran an operation like we did.

3/5/13   Presentation to the Scott County Board of Supervisors… Dr. Stephen Loyd also testified.

4/7/13   Dr. Reach and his wife Maggy are on ETSU Public Radio advocating for increase access to MAT.

9/20/13   Dr. Reach met at the Duffield, Virginia facility with Chief Investigator David Robbins from the Virginia State Police Drug Diversion Unit.  He was delighted to get a tour and educational presentation on MAT, and agreed to work together to prevent diversion.

10/11/13   Dr. Reach is interviewed on Christian Radio about MAT.

11/21/13   Dr. Reach met with several Judges at the Carnegie to discuss coordination of MAT with the Drug Court system in Washington County.

11/21/13   WRC Team attends our first Rural Access Medicine (RAM) event, providing free educational materials and counseling on addiction issues and working closely with other mental health providers.  We end up doing this multiple times a year for 5 years.

1/13/14    Dr. Reach is keynote speaker for the Southwest Virginia Substance Abuse and Mental Health forum in Marion, Virginia.

2/20/14   Dr. Reach presents MAT to the Bluefield, VA town council.

3/27/14   Dr. Reach begins the first of several meetings with Sheriff Lipford from Harlan, Kentucky addressing MAT, pharmacy access and diversion prevention.

4/30/14   The Watauga Foundation was formed as a 501c3 educational to help support WRC mission.

7/15/14   Dr. Reach presents to the Kingsport, TN OB/GYN group about MAT and the prevention of neonatal abstinence syndrome.

9/8/14   Dr. Reach makes full MAT presentation at the Wytheville, Virginia Recovery Coalition.

11/5/15   Dr. Reach presented MAT at the “Solutions Summit” in Knoxville for the leaders of Tennessee law enforcement and the Director of Substance Abuse and Mental Health Services.

9/13/16    Dr. Reach presents to town leaders and law enforcement in Wytheville, VA.

11/21/16    Dr. Reach, Dr. Loyd and the WRC team meet in in Duffield with the Chief Judge of the Virginia Circuit Court, The Honorable John C. Kilgore, to set up MAT for the drug court program.  Watauga Recovery Centers continued working with them until the Federal Raid.

1/5/17  Meeting with Thomas Howell from the Cocke County and Jefferson County Drug Courts.

1/12/17  Drug court Inservice for Scott County, Virginia probation officers.

2/8/17   Dr. Reach presents to the Johnson City Kiwanis Club.

5/2/17   WRC meets with Terry Cannon, Chief of Police, and Timothy Ward, Captain  in Greenville, TN.

5/18/17   WRC meets with Don Baird, Director of Morristown, TN Probation office.

6/5/17   WRC meets with Detective Jason Ramsey, Newport TN Police Department.

7/14/17   WRC meets with Major Sircy and Major Sells from the Cookeville, TN Police department, and then with the Putnam County Sherriff’s Department.

8/14/17   WRC meets with the Greene County Drug Court and Samantha Venerable about providing MAT to participants.

8/31/17   Dr. Reach speaks at the Overdose Awareness Day in Knoxville.

10/14/17   WRC meets with the Grainger County Sherriff’s Department

11/8/17   WRC meets with Scott County, VA Sherriff’s Department and Sherriff Puckett

1/5/18    WRC meets with Terry Cannon, Chief of Police and Captain Ward from the Greenville Police Department, Greenville, TN.