The DEA's disastrous war against pain-treating drugs

FYI.  This article also appeared in The Kentucky Post recently. 
Apologies for the longish post -- sometimes the links I included at
the end weren't working.

The DEA's disastrous war against pain-treating drugs
By Ronald Fraser

The very same federal agency that has repeatedly failed to slow
the flow of illegal cocaine from abroad, is now waging an alarmingly
successful war against legal prescription drugs here at home. Problem
is,
the Drug Enforcement Agency's efforts to keep legal drugs off the
black
market has a nasty side-effect:

Terrified of DEA, many hometown physicians no longer give 15 million
Americans struggling with chronic pain the medicines they need.

In 2002, according to Dr. Joel Hochman, director of the National
Foundation
for the Treatment of Pain, the DEA investigated 622 physicians,
brought
charges against 586, and in 426 cases medical licenses were revoked
"for
cause."

He warns, "If the DEA continues as at present, there won't be any
doctors
writing opioid prescriptions in two more years."

Opioids, like OxyContin, are highly effective painkillers made from
either
opium or synthetics with the properties of opiate narcotics. Roanoke
physician Cecil Knox, whose trial ended last week for prescribing
OxyContin
"outside the scope of legitimate medical practice" is, according to
the DEA,
a prescription-abusing doctor and a pipeline to drug abusers. But
some,
including other physicians, claim Knox did not violate medical
standards.
Instead, he simply cared for the difficult patients many doctors
prefer to
avoid.

The DEA justifies its actions against Virginia doctors this way:
"Virginia
is one of the half-dozen or so states commonly cited by law
enforcement and
medical practitioners when discussing the national OxyContin abuse
epidemic." Still, Virginia was ranked only 32nd in the nation for the
number
of OxyContin prescriptions written per capita in 2000.

It is true that some pain patients do sell their pills on the black
market.
Others sometimes overdose by mixing prescription medicines with other
drugs
and die as a result. And perhaps some profiteering physicians
knowingly take
part in these illegal schemes.

But most doctors under attack, says Hochman, are not deliberately
abusing
their professional responsibilities. They simply need better
pain-control
training and office management skills.

His solution is for the DEA, state regulatory agencies and state
medical
boards to work with, rather than against, the nation's 5,000 doctors
practicing chronic opioid therapy.

"To be a competent physician," says Hochman, "every doctor in the
United
States needs to be adequately trained - and most are not - in the
management
of intractable pain. Law enforcement and physicians must work together
to
separate the sheep from the wolves and to identify and prosecute the
small
number of prescription abusers. Targeting the physician only drives
legitimate pain patients into deeper despair, terminal hopelessness
and into
the black market for relief - as in the case of Rush Limbaugh."

The DEA's heavy-handed approach is a three-part recipe for disaster:

1: Abandoned patients. As doctors lose their licenses, the number of
abandoned patients goes up and all pain sufferers will have a harder
time
finding the care they need.

Where will abandoned pain patients find relief when other doctors in
town
are "narcophobic?" Many will turn to illegal channels, meaning the DEA
will
actually create new customers for the same black market in drugs it
claims
to be dismantling.

2: Fearful doctors. To avoid trouble with the DEA, fewer physicians
are
likely to start new pain care practices. Signs already appearing in
doctors'
offices read, "Do not ask me to refill pain medications" and "Don't
ask for
opioids," as doctors adopt a cover-my-rear medical ethic that ignores
their
patients' welfare.

Even nursing home care is being harmed. Until outside pain consultants
step
in, terminally ill nursing home patients are not getting the pain
control
medicines they need. Staff physicians are too afraid of the drug
warriors to
do their job.

3. Government intrusion. Despite surveys showing that seven of ten
Americans
want their doctors, not the government, to decide what medical
treatment
they will receive, an aggressive DEA is bullying the medical community
to
undertreat Americans with severe pain. How? Dr. Jane Orient, director
of the
Association of American Physicians and Surgeons, sums up DEA this way:

"Throughout the U.S., physicians are being threatened, impoverished,
delicensed and imprisoned for prescribing in good faith with the
intention
of relieving pain. Law enforcement agents are using deceitful tactics
to
snare doctors, and prosecutors manipulate the legal system to frighten
doctors who might be willing to testify on behalf of the wrongly
accused
doctors."

This year American taxpayers will give DEA about $120 million to
target
doctors who aggressively use legal drugs to ease pain. I wonder if the
millions of these taxpayers suffering from chronic pain, including
many in
Virginia, think this is money well spent?



Ronald Fraser writes on public policy issues for the DKT Library
Project, a
Washington-based civil liberties organization.

http://www.roanoke.com/roatimes/news/story157761.html  or  
http://www.mapinc.org/drugnews/v03/n1710/a01.html?186