Buzzby

Federal Crackdown On Pain Specialists Doesn't Help Patients
Martin L. Haines | Asbury Park Press | 12/15/05

In 2005, following a Drug Enforcement Administration investigation, Dr. William Hurwitz, a pain specialist in Virginia, was tried and convicted of violating the drug laws — prescribing excessive amounts of painkilling drugs and prescribing such drugs to drug addicts and other improper recipients. His penalty: 25 years in prison and a fine of $1 million.

At trial, Hurwitz testified that he acted at all times in good faith and was not aware of the diversion of any drugs. Sometimes, he detected drug abuse and terminated treatment or changed medications. He did not always stop prescribing opioids (painkillers) because he believed it was his professional obligation to address the medical needs of his patients.

It is estimated that as much as 10 percent of the population of this country lives with chronic pain and that nearly 11 million people, age 12 and older, used illicit pain relievers in 2002, according to the National Survey of Drug Use and Health. But the number of doctors involved with them is a question.

Hurwitz is only one of many doctors who risk criminal charges for prescribing painkilling drugs to their patients. The DEA argues that its investigations of doctors and its pursuit of sanctions against them involved less than one-tenth of one percent of the 963,385 doctors registered with it in 2003. In that year, the DEA investigated 557 doctors. Actions were taken against 441 of them; 34 were arrested.

This appears to be misleading — intentionally. A correct figure would report the total number of pain specialists in the doctor population, not the total doctor population, and divide the specialist number by total investigations.

Ronald T. Libby, writing for the Cato Institute in September and using a correct approach, concludes that 17 percent of pain specialists were investigated by the DEA in 2001, when there were 861 investigations of the roughly 5,000 doctors who treated pain.

Under the federal Controlled Substances Act, physicians registered with the DEA may prescribe controlled drugs, such as Oxycontin, if the prescription is issued "for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice" and if issued "in the usual course of professional treatment."

New Jersey has its own laws regulating the use of controlled substances. Doctors who prescribe them must obtain an almost all-encompassing medical history of the patient, including the "frequency and severity of any pain," any history of substance abuse, and the "recognized medical indication for the use of the controlled substance."

The DEA's pursuit of doctors who specialize in the management of pain has had significant repercussions. Many doctors are refusing to participate in the management of pain. They are unwilling to risk prosecution for prescribing the most appropriate controlled substances for pain relief. Medical students are being advised not to select a pain specialty for the same reasons.

There is increasing fear that those who live with chronic pain will be unable to obtain any relief for their condition.

Many reputable organizations, including the American Pain Institute and the Association of American Physicians and Surgeons, have protested DEA policies and practices concerning doctors who treat pain.

One significant response objecting to DEA doctor policies came in the form of a long, analytical letter from 32 attorneys general. New Jersey's did not participate. They said:

"In our consumer protection role . . . we have learned that adequate pain management is often difficult to obtain. One key contributor to this problem is that many physicians fear investigations and enforcement actions if they prescribe adequate levels of opioids or have many patients with prescriptions for pain medications."

The letter also pointed out that in 2001, the DEA and 42 health organizations had endorsed a plan balancing pain treatment and Controlled Substance Act enforcement policies. The DEA withdrew its acceptance of that plan this year and has offered no alternatives.

The continuing failure of the DEA to adopt a plan fairly regulating the management of controlled substances used by doctors to treat patients with chronic pain is a serious breach of the government's obligation to protect doctors and their patients. The failure to act reflects outmoded political attitudes about drugs in general as underlined by the continuing pursuit of the long-failed War on Drugs.

Regulating drug traffic has become more important than the welfare of human beings. This drug mania has overloaded our prisons with nonviolent drug offenders at an enormous cost, in addition to the annual local and national cost of The Drug War amounting to about $50 billion.

Humane treatment of people with chronic pain, the fair treatment of doctors and a decidedly more balanced approach to the problems of the pain addicted is long overdue.
--
Martin L. Haines, of Moorestown, is a retired Superior Court judge and a former State Bar Association president.

__________________

imported_Peace_Frog

I blame the American people for these injustices. I mean c'mon this is a democratic nation, anyone who has ever voted edit: for a winning candidate needs to be held accountable.


Take my advice you registered voters, elect a more competent DEA and injustices like this won't happen. (omitted)

Buzzby

What about people who consistently voted against the people currently in power?


Obviously, the DEA isn't elected. How does that prove your point? What is your point?

Mr_Master2

I think his point is that the fact that the DEA is not elected is part of the general unfairness and flat out crap that the American people have to put up with as a result of this "Drug War."

oneluv4boognish

I think that his point was that people in power (not sure if the DEA is one of those great agencies that fine people...i meant morons...) like George W. are able to appoint the head honchos. Hence his point would be to not elect dumbasses like George W. and maybe we'd have better people running the govt. agencies??? Or maybe that wasn't it....wtf was your point?

imported_Peace_Frog

Now that I look back on what I said, I didn't have a point and nothing I said made much sense (notice a trend?). Kudos to Buzzby for calling me out on that.

I was basically just trying to give a little social commentary on the flaws of the democratic process or lack thereof.

killer12382

The US isn't a democracy, it's a constitutional republic....there is a difference.