The DEA's disastrous war against pain-treating drugs
By Ronald Fraser
2 Nov 2003 - 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.