To NFTP Members and All Citizens

I have just returned from a meeting of the clinical investigators participating in a major and perhaps historic research project involving Kadian, a new form of sustained release morphine sulfate. I am bound by a confidentiality agreement to not reveal any information from the research until it is published professionally. But I can tell you that the drug is very effective in reducing the pain level and improving the quality of life of more than 1100 patients participating in the clinical study. It has provided scientifically unimpeachable evidence that the adequate treatment of pain in safe and entirely available.

Unfortunately, the final presentation at the conference was given by Dr. Roger Cicala, Assistant Medical Director of the Tennessee Medical Foundation's Physicians Health Program. Dr. Cicala is a highly experienced pain management specialist and addictionologist, and has been a professional consultant to the Drug Enforcement Administration. He spoke about the legal issues involved in prescribing opioids. When he finished his presentation on the guidelines, rules, risks and potential consequences of prescribing opioids, one could have heard a pin hit the floor.

As one physician later commented, "I am a family practitioner. Listening to Dr. Cicala, there is no way that I can devote the kind of time to record keeping and defensive medicine that is required to keep me safe from being prosecuted. It just makes me want to entirely give up pain treatment."

I am going to ask Dr. Cicala to provide me his lecture in a written form, to post on the web-site. I think it is very important for every pain patient to understand, precisely, what risks are involved for any doctor undertaking the responsibility of their care.

• The death of a patient, the complaint of an opiophobic spouse, pharmacist or emergency room doctor, or insurance company (they hate the expense), can spark an investigation.

• Being the only doctor in town willing to treat pain can cause the doctor to be flagged by computer programs monitoring opiate prescriptions, both at state and federal levels.

• A District Attorney who is not educated about pain management, or who is politically ambitious, or has a personal ax to grind, can initiate a criminal prosecution in an instant.

It is now not uncommon for a swat team to break into a doctor's office, put everyone on the floor at gunpoint, and remove patient charts and office computers. Just a few years ago this was inconceivable. Now it is a fact of medical life. Any doctor to whom this happens can expect a legal bill of $750,000 to achieve exoneration. So, even if totally legitimate and honest, these doctors are punished unimaginably. Ask Dr. Frank Fisher and Dr. Robert Weitzel.

The Drug War has become a drug insanity. The mad freneticism to eliminate diverted drugs from the streets is out of control. There is also even an element of class warfare involved, as some law enforcement figures achieve a special glee in "bringing down big-shot doctors".

The National Foundation for the Treatment of Pain is a small organization. We have just 1500 dues-paying members. But we believe that the power of an idea goes far beyond the size of one's membership. Our web site receives over 13,000 hits per day. And our work has become well known throughout the nation. In the face of what is happening in this country, when pain patients find themselves in the social position that people of color were in 1950, and their doctors are treated like "communists", we are taking the following initiatives.

1. NFTP has initiated Pain Practice Liability Insurance (www.upaaus.com). For $125 a month pain practitioners will soon be able to purchase insurance to pay their legal expenses, equip them with the best legal representation in the country, and place the full authority of a Professional Advisory and Review Committee into the arena of expert witness about what constitutes judicious medical practice. The Professional Advisory and Review Committee, comprised of independent, nationally recognized medical and legal experts, will bring science and sanity back into the picture. Science and fact will become a "1000 pound gorilla" on the side of medical professionals, who have been abandoned to media frenzy, drug-war witch hunting, and pharmacological McCarthyism.

2. The NFTP is now starting a campaign of national awareness. It asks that every pain patient, pain specialist, family member, and concerned citizen, join in this campaign by purchasing the lapel pin of this cause, the soaring bird against a crimson sky, and wearing it constantly. When asked, every person wearing the pin can then explain about the problems of pain treatment, opiophobia, drug-war McCarthyism, the OxyConjob, and the persecution of physicians.

With this campaign we can make every person in the United States thoroughly informed about the war on pain patients and their doctors. Go to www.paincare.org and join. Your pin will quickly enlist you in the battle. With it will come a concise statement of the issues, the facts, and the remedies. When a million people wear the pin, the war on pain patients and their doctors will be finished.

We cannot fail in the campaign to bring the United States into the 21st century of medicine and science. Pain management is safe, life-saving and imperative. The problems of diversion, addiction and illicit drug use have absolutely no logical connection with the legitimate treatment of pain. If there are doctors out there who are criminals, then the State Medical Boards will remove them from the practice of medicine. But jack-booted Swat Teams holding patients at gunpoint is an obscenity which we cannot tolerate. And no one should be asked to believe that 1 out of every 1400 doctors in the United States is a criminal, selling prescriptions for drugs, motivated by greed. (There were, according to the DEA, 621 doctor investigations in 2002 and 597 convictions, for narcotic offenses).

Join with the Foundation. The life you save, may be your own. None of us is more than a slip in the bath-tub, or an accident on the freeway, away from becoming a member of the pain patient underclass - persecuted, demonized, denied, abused and demeaned. We must stand together, for the sake of humanity. If you are a doctor, buy Pain Practice Liability Insurance and save our profession from fascism. If you are patient, a member of a patient's family, a neighbor, or a simply a patriotic American, join the campaign for awareness.

J.S.Hochman MD
Executive Director
NFTP