The Painful DEA
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
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:
- 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.
- 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.
- 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
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
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
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
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
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.
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
"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:
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
- 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.
"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
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