The Painful DEA

By Michael Arnold Glueck, M.D. and Robert J. Cihak, M.D.

Tuesday, May 6, 2003 - Everybody knows what a "symptom" is. It's an indicator of something else. Some symptoms, such as a runny nose, can indicate something as trivial as a head cold. Other symptoms point to far more debilitating or even deadly conditions.

This article is about the Drug Enforcement Administration (DEA) inflicting pain on both patients and doctors and what this symptom might mean.

Way back during the so-called Progressive Era a century ago, a de facto alliance of physicians and bureaucrats undertook to regulate the possession and distribution of drugs, especially those that affected the sensation of pain.

Their intentions, like those of the temperance movement, were humane, at least in theory. They had seen what morphine addiction had done to a generation of Civil War veterans; they'd watched too many middle-class matrons quietly wasting away on laudanum, an opium preparation. They wanted to help.

Whether they did or did not help is debated to this day. But never could the most ardent Progressive do-gooder have imagined that today, anti-drug laws would be used by overzealous bureaucrats and frenetic enforcers to deny patients desperately needed treatments, or drive physicians out of medical practice or send them to prison.

No, we're not talking here about legalizing marijuana or about the tiny percentage of doctors who criminally abuse their prescription pads and belong in jail. We're talking about government agents making it ever more difficult for patients in severe pain to get relief as these government officials take unto themselves the "responsibility" of keeping patients from becoming "addicted" to drugs that allay their suffering and enable them to survive.

Publicly, the feds make all the right noises. Asa Hutchinson, former DEA director, speaking to a meeting of the American Pain Society on March 14, 2002, told doctors:

"... we trust your judgment. You know your patients. The DEA does not intend to play the role of doctor. Only a physician has the information and knowledge necessary to decide what is appropriate for the management of pain in a particular situation. The DEA is not here to dictate that to you. .... We never want to deny deserving patients access to drugs that relieve suffering and improve the quality of life."

But consider what the drug enforcers actually do:

  1. Dr. Deborah Bordeaux of South Carolina was convicted under a "drug kingpin" statute carrying a mandatory minimum sentence of 20 years, even though she'd worked only two months in a temporary position treating chronic pain and other ailments.

  2. The late Dr. Benjamin Moore, working briefly in the same clinic, pleaded guilty although convinced of his own innocence, and then committed suicide rather than testify against others.

  3. Dr. Jeri Hassman of Arizona, who had the largest pain practice in Tucson, is being threatened with a 28-year prison term, apparently because a small fraction of her patients used prescriptions in unauthorized ways.

Mere anecdotes? Perhaps. But then, the plural of "anecdote" is "data." And there are many, many more examples.

Other government actions "send the same message." At a pain management conference sponsored by the Pima County Medical Society of Tucson, Ariz., speakers such as David Greenberg, M.D., MPH, chief investigator for the Arizona Medical Board, and Neil Irick, M.D., a pain specialist from Bloomington, Ind., told doctors to protect themselves by using surveillance cameras and urine drug screens to make sure each patient is as "clean" as he or she claims to be.

Further, to make sure the patient isn't importing somebody else's clean urine, they advised doctors to frisk patients before they give the urine specimen and then to maintain a chain of custody for the specimen, the same way police treat specimens from criminal drug suspects.

In other words, doctors should consider their patients to be criminal suspects until proven innocent.

The Association of American Physicians and Surgeons (AAPS) is now warning doctors to avoid medicines out of favor by DEA officials and to avoid prescribing more medicine than the DEA finds "usual" lest more doctors suffer similar, painful fates.

Again, we're not talking here about street drugs. We're talking about doctors prescribing legal drugs to patients who may not be able to survive, let alone function, without them.

For example, some patients with cancer pain lose their appetite and can't keep food down; without adequate and appropriate treatment for the pain, these people starve to death and die quickly. But with adequate treatment, many of these same people regain their appetite and strength, and live for many years.

And as the "guilty until proven innocent" standard comes to apply to doctors as well as patients, more and more physicians begin to practice that ultimate form of "defensive medicine" quitting their pain management practice or getting out of medicine entirely.

But the problem goes much deeper than out-of-control drug cops. The government is relentlessly forcing the American physician to become the servant of the state, as hyper-regulated caregiver and as on- call policeman, under constant threat of criminal prosecution.

As usual, we recommend that you write the president, senators and representatives in Congress and tell them to stop treating doctors as criminals. Now, given these symptoms, ask yourself: "Where does it hurt?"

The Painful DEA - Part II - Halt War On Physicians

A Campaign to Stop Prescription Drug Abuse

- and Halt 'War on Physicians'

Michael Arnold Glueck and Robert J. Cihak

Tuesday, July 1, 2003 - Prosecutors and law enforcement officials throughout the country are egregiously targeting doctors for helping patients manage crippling pain with controlled, legal drugs.

We've addressed this topic before ("The Painful DEA") but find the need to keep commenting until justice is done and the Drug Enforcement Administration (DEA) and other government officials get it right.

Judging from letters we've received, many people ("particularly seniors, the chronically ill and disabled") are very upset about the DEA's interference with their ability to receive appropriate medical treatment.

For example, in an overzealous prosecution, the Arizona medical community was shocked by the indictment of Tucson physician Jeri Hassman, M.D., on charges stemming from her legal prescriptions for pain relief for her patients.

Speaking at a news conference on June 26 at Hassman's Tucson offices, Jane M. Orient, M.D., Executive Director of the Association of American Physicians and Surgeons, explained why AAPS has decided to support Dr. Hassman:

"Throughout the United States, physicians are being threatened, impoverished, delicensed, and imprisoned for prescribing in good faith with the intention of relieving pain."

For some government officials, the "War on Drugs" has come to also mean a war on lawful drugs and against the doctors who prescribe them and the patients who take them. Some prosecutors try to make political careers out of high-publicity cases involving the hot "drug du jour" such as OxyContin. But this war is causing enormous collateral damage and deaths to innocent patients from "friendly fire."

Physicians have been drummed out of practice, jailed and even driven to suicide in the face of these 21st century witch hunts.

"These doctors are treating patients at great personal risk. If this continues, not one doctor will be willing to prescribe the medications that patients so desperately need," warned Dr. Orient.

The real problem is not drugs, but drug misuse. Drugs are dangerous and must be treated with respect. Yet to many patients, drugs are life-saving.

"Law enforcement agents are using deceitful tactics employed to snare doctors, and prosecutors manipulate the legal system to frighten doctors and patients who might be willing to testify on behalf of the wrongfully accused doctors," said Orient. For example, she explained that law enforcement sends undercover actors to doctors to feign pain and beg for drugs.

Several of Hassman's patients spoke about the debilitating pain they suffer and their problems finding doctors to treat them now that their doctor's license and ability to write prescriptions have been suspended. Physicians at the press conference confirmed they now practice in an atmosphere of fear and intimidation.

Physicians and pharmacies already do report potential "drug-seeking" patients to law enforcement, yet are never warned by law enforcement officials about patients they believe are "drug seekers" trying to take advantage of physicians or pharmacies. Communication is flowing in only one direction.

Law enforcement uses outdated norms for assessing excessive prescribing. Investigators frequently look at the volume and duration of drug use as the primary trigger for an indictment. This is no longer appropriate, as standards for appropriate and accepted treatment have changed, leading to indictments of pain specialists simply due to the volume of their necessary prescriptions.

To stop the misuse of prescribed drugs without depriving patients of life-saving medication requires cooperation between police and physicians, not persecutions and prosecutions In order to focus the debate on criminals rather than innocent patients and doctors, AAPS kicked off a national three-point "Communicate and Cooperate" campaign at the press conference to work with law enforcement, making the following recommendations:

  • Work Together

    Doctors, pharmacists and law enforcement officials should work together to track and report potential drug abusers to each other.

  • Professional Medical Review of Potential Cases

    Before charges are filed against a pharmacist or doctor, a review board of medical professionals should meet under the auspices of the Department of Justice to assess a physician's practices, rather than totally relying on judgments made by non-medical police and prosecutors.

  • Mutual Training and Communication

    Law enforcement investigators should received training in modern medical treatment and current trends. Medical professionals should be informed of suspected drug abusers.

Notes Orient,

"In the art of medicine, investigators must be able to distinguish between a difference of opinion in what is proper treatment, and specific criminal intent. The DEA could pull the plug on most drug diversion by working with doctors instead of against them."

Currently the war on legal drugs ensnares too many doctors and not enough dealers. Those who require legal medications ought to be able to receive them without their doctors and pharmacists going to jail!

Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a former president of the Association of American Physicians and Surgeons.

You can contact Drs. Glueck and Cihak by e-mail at
[email protected]

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