PRN TO NEW YORK ASSEMBLY HEALTH COMMITTEE ON A10407

I want to thank the committee for hearing my testimony today. My name is Siobhan Reynolds, I am the President of the Pain Relief Network, a web based advocacy organization working to make pain care available to the American people.

I asked to come before you today to emphasize the shocking situation currently facing patients in pain and their families. But also to discourage you from adopting the provisions in the bill before you. (A10407)

You need look no further than the Roadblocks To Relief Study, put out by the American Pain Society to find your incontrovertible proof that we are enduring an ongoing public health catastrophe. With between 50 and 70 million Americans in untreated disabling pain and between 7 to 9 million of them in out-of-control pain, it is clear that something in our country is terribly, terribly wrong.

I returned late last night from Arlington, VA where I was attending opening arguments of the federal criminal trial of prominent pain specialist, Dr. William Hurwitz. Listening to the arguments of US Department of Justice Prosecutors and seeing that over 150 federal agents spent the day in the courtroom supporting the prosecutors, I got a sense for the problem that I want to share with you.

Mr. Lylte, the Justice Department lawyer who delivered the opening statement for the government referred to the medications prescribed by doctor Hurwitz as drugs which "ravaged the lives of his victims." These victims the government was referring to are the drug dealers who were part of a gang of con men who were working Dr. Hurwitz to get drugs to sell. Interestingly, all of these victims also had medically verifiable reasons why they might have serious pain, and the first prosecution witness who testified yesterday talked repeatedly about his pain and suffering.

When I watched this man walk up to the witness stand in his prison garb I thought at first - "Good God, Dr. Hurwitz, how could you have not seen who this guy was?" But as this man, who is serving eight years and whose testimony against Dr. Hurwitz might very well get him released immediately-as this man spoke, I could finally grasp how this could have happened.

This person in pain, this drug dealer, this con artist, talked about his lying in such an open and non-manipulative fashion, the effect was remarkably charming. As he clearly meant no malice when he lied to get what he wanted. (it was obvious that this was his general approach to life) I could see how Dr. Hurwitz could have been fooled by him. Most doctors would simply refuse to see such a man, his criminal past and his poverty would be viewed as unacceptable risk factors-but Dr. Hurwitz did his ethical duty as a physician and treated the man's pain-that is until the man was arrested selling some of the prescription medications Dr. Hurwitz had prescribed in good faith.

When the DEA discovered that this man and others were conning Dr. Hurwitz, what do you think they did? Do you think they informed Dr. Hurwitz? Do you think they shared with him the evidence they had that would prove that these people were diverting their medications? Well, they didn't. And my experience in other cases against doctors is that they never do. The DEA runs drug prosecutions against people they think they can convict of drug dealing. It is successes in prosecutions that they sell to the Congress to get more funding.

Ladies and Gentlemen, physicians who treat pain are in an impossible position. They are required by medical ethics to believe their patients self-report of pain, but if they do, they might be victimized as Dr. Hurwitz has been. The saddest part of all, and this I have to emphasize, is that as a result of this extraordinary law enforcement pressure on medicine, physicians have come to see the patients as adversaries, people who have to be controlled, suspected, routinely drug tested and investigated-all of which has utterly destroyed the trust between doctor and patient which is absolutely necessary to a therapeutic relationship. It is also destroying patients and their families by the hundreds of thousands. Everyday at Pain Relief Network either I, or my staff find ourselves talking people, sometimes doctors, out of suicide. As our society does not keep statistics on suicide that results from untreated pain, the consequences of our failed policies are hidden from the public and legislators alike.

The system is destroying our most vulnerable citizens, all in the name of keeping addicts from harming themselves. 40,000 people die per year as a result of car accidents-yet we do not scrutinize car buyers or paralyze our transportation system in order to prevent these deaths.

Patients do not get addicted to opioids and only a tiny number of people die from opioid overdose every year. The number in the year 2000, in fact was less than two hundred, and the vast majority of those deaths were associated with ingestion of other drugs and alcohol. The problem for the Department of Justice is not that these drugs are dangerous. The problem for the Department of Justice is that they are not.

Over the years, as the medical world has pushed for physicians to treat pain, promulgating guidelines, passing intractable pain acts, and otherwise working to alleviate this terrible problem, federal law enforcement has been trumping these efforts by instituting measures of their own. With the development of drug task forces that essentially obliterate the line between state and federal police powers as regards the regulation of medicine, the DEA has used the Controlled Substances Act to utterly subvert the state's regulation of medical practice. Adopting laws at the state level to further subject physicians to more scrutiny, more education requirements, more documentation requirements and sanctions, will only further ghettoize pain treatment in the state of New York. It has been my experience, and it was amply demonstrated yesterday, that all of these extra requirements only give prosecutors more details to damn doctors with. As a result, they hurt and do not help patients in pain.

Since 2001, thousands of physicians have been induced by the DEA to simply hand over their DEA certificates rather than face what Dr. Hurwitz is facing. By the DEA's own numbers, well in excess of 200 physicians have been arrested on criminal charges. And perhaps most disturbing of all, changes in the Federal Sentencing Guidelines, changes that apply only to pharmaceutical oxycodone, cause the drugs to be weighed up and calculated at sentencing such that one bottle of Oxycontin that the DEA can find that a doctor has prescribed improperly, can net the physician a sentence in the triple digits. I kid you not.

At PRN we have brought an appeal for a whole clinic's worth of such physicians in South Carolina, specifically on behalf of Dr. Deborah Bordeaux, a dedicated physician who worked for a targeted clinic for 57 days, prescribing very modest doses of pain medication and who the government later insisted serve 100 years in prison. While in 2001 a gram of Oxycodone, the active ingredient in Oxycontin was calculated as the equivalent of 500 grams of marijuana for sentencing purposes-in 2003 the guidelines changed that to 6700 grams. Again, my message to you is, there is something terribly, terribly wrong.

What has happened is that the criminalization of drugs, as our country's sole method of drug control, has required law enforcement to regulate medicine as it concerns the treatment of pain. As the CSA requires the DEA to judge medical practices and to decide which are in fact medical practices and which are not, they have promulgated standards by which to make this determination. As these standards are necessarily not scientific and based on more than anything else, law enforcement folklore and superstition, physicians who attempt to treat pain are risking their medical licenses, financial security, their family's futures, and their very freedom, every time they prescribe medicines for pain. Is it any wonder that patients in pain, who need these medicines every day to survive are routinely denied care and systematically abused by the medical system?

At PRN, we oppose even the educational aspect of this bill because the main feature of educational programs designed to teach pain treatment to physicians these days, consist mainly of methods by which physicians are supposed to decide who is and who is not scamming them. The adoption of these law enforcement standards into the practice of medicine is a travesty which stigmatizes and destroys patients all over this country every day. Please don't adopt them as law in New York State.

In conclusion, we are here to tell you that this madness must end. We urge you to leave NY doctors alone and support our efforts to address this problem at its source-at the flaw in social policy at the national level responsible for this catastrophe.

Thank You.

Siobhan Reynolds