DEA Silent One Year
After Office Raid

4/30/06 - A year after agents from the federal Drug Enforcement Administration raided his Billings medical practice, Dr. Richard A. Nelson is still wondering whether he'll be charged with a crime.

"We haven't heard a damn thing," said Nelson, a neurologist who specializes in care for chronic pain. "It's been silent."

DEA agents executed an administrative inspection warrant on Nelson's West End office in April 2005. They took 72 patient files, which were later returned, and suspended his ability to write prescriptions for about 200 medications, including narcotic painkillers.

Federal officials never said what prompted the investigation, but people who were questioned by DEA agents, including Nelson's patients and employees, said the inquiry focused on diversion.

Diversion is the illegal distribution of legal drugs, such as painkillers that are prescribed to people suffering from chronic pain.

Suzanne Halonen, a DEA public affairs officer in Denver, said she was not aware of any new developments in the year-old investigation, which she indicated had been turned over to the U.S. Attorney's Office in Billings.

"It's not unusual for complex cases to last a very long time, sometimes several years, before there's any conclusion," Halonen said.

Assistant U.S. Attorney Kurt Alme said he could not comment on the status of the case or even whether there is one.

"We can neither confirm nor deny the existence of an investigation," Alme said.

Nelson insists he did nothing wrong. He said he thinks the DEA identified him as an easy target because he is a solo practitioner who is nearing the end of his career.

"I think they do this on purpose," he said. "They attack doctors who are older and ready to retire anyway."

Before the raid, Nelson figured he was about 18 months away from retirement. He said he will have to work longer than that now to finish paying off his practice.

Critics have accused the DEA of putting physicians who prescribe narcotic painkillers, known medically as opioids, out of business as a way to justify its war on drugs.

"I really think the DEA, when they look at this, they go, 'Boy, this Dr. Nelson is maybe prescribing 50 percent more narcotic pain medications than anyone else in the area,' and they are automatically suspicious of something," said Mike Bledsoe, a former patient of Nelson's who takes opioids to ease chronic pain from a work-related injury. "There's no proof that anything (illegal) is going on."

According to Bledsoe, Nelson had more chronic-pain patients than did other Billings clinicians because he treated pain sufferers with respect.

He is not surprised that Nelson has not been charged with a crime or other violation.

"I think it was just a matter of the DEA looking at statistics and saying, 'We're going to stop this guy because we don't like what he's doing,'" Bledsoe said.

The DEA maintains that it investigates doctors only when there is evidence of illegal activity. In a January 2006 letter to The Gazette, the special agent in charge of the agency's Denver office said doctors who have done nothing wrong have nothing to fear.

"Practitioners who treat a patient with chronic pain in accordance with acceptable medical standards have no reason to fear a DEA investigation and should treat their patients accordingly," wrote Jeffrey D. Sweetin. "DEA investigations of practitioners are initiated when there is suspicion of criminal activity ... DEA must have conclusive evidence of wrongdoing in order to go forward with criminal or administrative actions."

The letter appeared to be in response to The Gazette's coverage of the Nelson investigation.

Nelson remains in good standing with the Montana Board of Medical Examiners, which first licensed him in 1970, and he has asked the DEA to reinstate the certificate that allows him to write prescriptions. He suspects the agency will ignore his request.

He continues to see patients, although the focus of his practice has shifted toward alternative pain-control methods, such as acupuncture, herbal patches, neurofeedback and relaxation techniques. Nelson's wife, Jerrie Lynn, is trained as an alternative practitioner.

Still, his appointment book is usually about half full. Many of his patients, including Bledsoe, had to go elsewhere for medical care so that they could refill their prescriptions for painkillers.

In the weeks after the raid, some of Nelson's patients reported being unable to find other local doctors to treat them.

"We weren't treated good by doctors at the hospitals," Bledsoe said. "They just viewed us as junkies, I guess."

Patients said some clinicians told them they would not take chronic-pain patients because they were afraid of drawing the DEA's attention.

"The DEA has really intimidated these doctors into saying, 'I will never prescribe these medications." Bledsoe said. "It's a tough situation."

Dozens denied pain drugs
after DEA raid

Dr. Richard A. Nelson called about 50 patients to his office last Thursday to deliver the news: federal officers had raided his office, seized records and told him to stop prescribing certain narcotic painkillers.

The patients, whom Nelson treated for chronic pain from injuries, cancer and other ailments, were shocked.

"We were angry and I guess a bit frightened about what we're going do, who's going to treat us," said Mike Bledsoe, 52, who has been seeing Nelson for about two years to ease the agony of a work-related injury and other problems. "It's a bad situation."

Some patients have contacted the office of Sen. Conrad Burns, R-Mont., asking about the April 20 visit by the Drug Enforcement Administration to Nelson's office.

"Something needs to be done," Bledsoe said. "This is not, as the DEA might put it, a drug-dealing doctor treating a bunch of junkies. That's not what's going on here."

DEA officials won't offer specifics about the case except that agents served an "administrative inspection warrant" at Nelson's office and seized records and some pharmaceuticals. The raid was low-key - no drawn guns or SWAT gear.

No one has been arrested and no criminal charges have been filed.

"This is an ongoing investigation," said Karen Flowers, a DEA spokeswoman in Denver.

The DEA in recent years has been cracking down on the illegal sale of pharmaceuticals, including the painkiller OxyContin. Flowers said an estimated 15 percent of all controlled substances make it to the illegal market - a process called "diversion" when a patient resells medication - accounting for about $25 million in sales each year.

"Somebody can make a lot of money in diversion," Flowers said.

Nelson, who said he has done nothing wrong, said the DEA never told him what the case is about.

"They just came in and grabbed the charts," said Nelson, a neurologist who has been practicing medicine in Montana since the 1970s and has an unblemished record with state medical officials.

Nelson has been in contact with lawyers and said he plans on speaking with a lawyer in San Francisco who has dealt with other pain-relief doctors who have had run-ins with the DEA.

Meanwhile, Nelson has stopped prescribing narcotic drugs that his patients have come to rely on, he said. Instead, he's referring them to alternatives that "muffle" the pain but may not be as effective.

Nelson started treating patients with chronic pain about three years ago. His office on South Frontage Road serves a wide range of patients, including some dealing with severe pain who need strong narcotic medications.

"A lot of people come in because they didn't have any place to go," Nelson said, adding that the situation emphasizes the need for a comprehensive pain management center in each city.

Bledsoe, one of Nelson's patients, hurt his back in January 2001 while working as a union electrician in Gillette, Wyo. Years of heavy industrial work also had taken a toll and, he later found out, his body was suffering arthritis, degenerative conditions and other problems.

Lifting a cup of coffee or climbing a set of stairs could be debilitating.

"The pain transforms your life," he said.

Bledsoe spent 18 months working with a doctor in Sheridan, Wyo., trying to find suitable medication. Finally, a little reluctantly, he tried OxyContin, a time-release narcotic that Bledsoe said provides some relief.

When he moved to Billings, Bledsoe checked in with several doctors and was eventually referred to Nelson. Bledsoe said the doctor was professional, cautious and thorough and helped find the right combination of medications "so I could be operational."

His heart sank at the meeting last week when Nelson told his patients that he'd been told by DEA not to prescribe certain medications. Bledsoe, who said he needs Roxicodone and Dilaudid, isn't sure whether he and other patients will be able to get the medication they need.

"It's going to put a lot of people back to a world of pain," he said.

Five of Nelson's patients contacted Burns' office concerned about what do, said Grant Toomey, a Burns spokesman. The patients were told to seek another doctor or go to a hospital emergency room.

"We'll certainly keep tabs on it, but as an ongoing (DEA) investigation, it really falls above our heads," Toomey said.

Similar situations have occurred elsewhere in recent years, according to Siobhan Reynolds, president of Pain Relief Network, a New York-based group that says it advocates for patients with chronic pain and the doctors who treat them.

"The DEA has been going after doctors en masse," Reynolds said. "It's mostly in out-of-the-way places like Erie (Pa.), Billings, Iowa and Indiana."

Last month, a nationally known pain specialist in Virginia was sentenced to 25 years in federal prison in a case where prosecutors said he was willfully ignorant that some of his patients were selling their prescription drugs or using them recreationally. A few of his patients also overdosed, prosecutors said.

Reynolds said the recent activity may have a "chilling effect" on other physicians who deal with management of severe and chronic pain, especially when they are targeted for the behavior of drug-selling patients.

"In any practice, a certain percentage of the patients are going to do that," she said. "It's an impossible situation for the physicians."

The American Medical Association in 2003 adopted a policy statement opposing "the harassment of physicians by DEA agents in response to the appropriate prescribing of controlled substances for pain management."

"The AMA is committed to the goal of protecting the legitimate use of prescription drugs for patients in pain," the AMA said on its Web site.

With his medications expired for the month, Bledsoe went to the emergency room on Tuesday afternoon. He was told that he can't get a scheduled appointment until next week and can't get a prescription for the medications he used to get through Nelson.

"I don't know what to do right now," he said.

Why Is The DEA
Hounding This Doctor

07/18/2005 - On a cold morning last April, inthe shadow of Montana's Beartooth Mountain range, five agents from the federal Drug Enforcement Administration (DEA) walked into the office of Dr. Richard Nelson, a Billings neurologist. For six hours, they combed through his records, seizing 72 patient charts and confiscating his drug-dispensing permit. The charge? None so far, but the assumption is that he is suspected of improperly prescribing narcotic drugs. Despite a distinguished professional record spanning more than four decades, Nelson has had to spend $20,000 on lawyers, fearing that the government will indict him if it turns out that one of his patients has misused his medicine. "My practice is sunk," says the 73-year-old physician, who specializes in chronic-pain treatment. "I can't even write a prescription for Tylenol 3 if someone has a migraine."

The DEA, for its part, says it was acting on tips from "several individuals in the community and pharmacies regarding suspicious prescriptions," according to a spokesman, who declined to elaborate.

It's a messy situation. No one is denying that federal and state officials, under pressure to combat a spike in pain-killer abuse, are waging an escalating war on drugs that is spilling into the waiting rooms of neighborhood doctors. Over the past six years, more than 5,600 physicians from Alaska to West Virginia have been investigated on suspicion of "drug diversion." Some doctors allegedly prescribed narcotics too freely, while others issued them to patients who turned out to be dealers or addicts. More than 450 doctors have been prosecuted on charges ranging from illegal prescribing and drug trafficking to manslaughter and murder.

But in the government's new crackdown, legitimate physicians and patients may be getting caught in the net. "Fifty million Americans are in severe pain from arthritis, back injuries, cancer and other disabilities," says Dr. Scott Fishman, president of the American Academy of Pain Medicine. "But the government is sending a message to avoid prescribing strong pain-killers."

Ultimately, it may be the patients who get hurt most, because a growing number of doctors, frightened of government scrutiny, are avoiding the use of powerful narcotics such as OxyContin, Vicodin, Percocet and Dilaudid. "It is impossible to be sure that a patient is not diverting any of his medication," says Dr. Thomas Stinson, a Medford, Mass., anesthesiologist who is closing his 20-year practice to new pain patients. "I fear I might be targeted."

In the past year, hundreds of sufferers have contacted the Baltimore-based American Pain Foundation. "They've gone to every physician within hundreds of miles and can't get someone to prescribe to them," says executive director Will Rowe. In some cases, patients with high-dosage prescriptions are turned away by drug stores, which are also subject to DEA investigations. "It's demeaning," says Mary Vargas, a Maryland attorney whose spine was injured in an auto accident. "Pharmacists tell me they don't have the medication, only to recant and dispense it when I persist with the manager."

The pain wars escalated last April when Virginia internist Dr. William Hurwitz was sentenced to 25 years in federal prison after 16 former patients testified against him and a jury found that the death of another patient was caused by an overdose. Hurwitz's assets were seized, and now he is appealing his conviction with the help of the pain foundation and the Association of American Physicians and Surgeons. Hurwitz defenders acknowledge that he may have practiced overly aggressive medicine and allowed addicts to snooker him, but insist he never profited from drug sales and was not a criminal. "Maybe his license should have been suspended," says Dr. Russell Portenoy, chairman of the Department of Pain Medicine and Palliative Care at Manhattan's Beth Israel Medical Center. "But there was no evidence that his patients were not in pain."

That's not how DEA administrator Karen Tandy sees it. "Dr. Hurwitz was no different from a cocaine or heroin dealer peddling poison on the street corner,"" she told reporters after his sentencing. Prosecutors said Hurwitz prescribed "obscene" amounts of medicine to patients he knew were addicted to cocaine and other drugs. As for the DEA's other investigations and prosecutions,

"We're not on a witch hunt," Tandy told TIME. "We are very careful in our investigations. More than 600,000 doctors are registered to prescribe controlled substances. There are a very small number of bad apples." Her agency, she says, has stepped up its investigations because of an "explosion" of illegal-prescription-drug abuse. "People are dying out there."

The use of opioids--medicine originally derived from poppies--dates back thousands of years. They were widely available in the U.S. until the public, alarmed by the growing number of addicts, called for strict anti-narcotics laws in the early 20th century. In the public mind, opioids such as morphine and laudanum, although they remained the most effective pain relievers, became associated with their illegal cousins--heroin and opium--and doctors often shied away from prescribing them.

But opioids made a comeback in the 1980s, after patient groups and physicians focused attention on the problem of under-treated pain. Research showed that addiction did not necessarily result from aggressive, well-managed opioid therapy. In the 1990s, as the specialty of pain management grew in hospitals and universities, opioid use spread from cancer and end-of-life patients to the chronic-pain victims of industrial accidents, car crashes and conditions such as migraines, diabetes and rheumatoid arthritis.

But as local internists began to prescribe stronger pain-killers for regular patients, some of those drugs--no one has reliable figures--began to flow into the black market, whether through pharmacy and warehouse theft, Internet sales or the scamming of legitimate doctors. When OxyContin, a time-release version of the opioid oxycodone, was introduced in 1995, drug addicts learned to grind up the pills to get a quick, intense high; in pockets of Appalachia, Maine and Ohio, OxyContin became the drug of choice. Meanwhile, celebrity abusers--including Rush Limbaugh and Courtney Love--sparked a flurry of publicity, leading politicians to push for a crackdown on what was being called an epidemic of prescription-drug abuse.

But the dimensions of that epidemic are in dispute--and from unexpected quarters. Last week a spokesman from the White House Office of National Drug Control Policy warned TIME that while prescription-drug abuse is a serious problem, and growing among teens, the numbers in a highly publicized study from Columbia University's National Center on Addiction and Substance Abuse are "not a reliable estimate." The survey describes a near doubling of prescription-drug abuse from 1992 to 2003, but because of changes in the way federal statistics were gathered in the past decade, no such claim can be made, the spokesman said. Last month the libertarian Cato Institute issued a report, Treating Doctors as Drug Dealers: The DEA's War on Prescription Painkillers, charging that the agency exaggerated reports of OxyContin deaths and overdoses. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, which can lead to intestinal bleeding, cause 35 times more deaths a year than OxyContin, the Cato report contended, and are far less effective.

The DEA's $154 million drug-diversion campaign is also under attack by state officials. In a stinging 10-page critique issued last March, 32 state attorneys general, led by Oklahoma's Drew Edmondson, charged that the agency's proposed criteria for investigations would force severely ill patients to make frequent, unnecessary doctor visits, thus increasing both their hardship and their co-payments. "DEA is creating a climate that ... discourages good practice," they wrote. Tandy met with a delegation of attorneys general in April to reassure them that "the last thing DEA wants to do is to chill the legitimate prescription of pain medications," promising that new rules would balance medical and legal concerns. Meanwhile, 25 states are taking the initiative, mounting their own electronic systems in pharmacies to catch suspect patients.

As the national debate plays out, Nelson, the Montana neurologist, remains under investigation. He describes himself as a cautious prescriber. A graduate of Washington University School of Medicine in St. Louis, he also trained with the American Academy of Pain Medicine. He required that his patients sign a four-page, 21-item contract before getting any opioid treatment, pledging, for example, that they had never received a diagnosis of substance abuse or been involved in drug dealing, that they would not seek to replace lost medication or obtain early refills and that they would buy their drugs from only one designated pharmacy. Monthly checkups and extensive tests--including MRIs and electromyographic studies--were the norm, Nelson says. Over the years, he has dismissed more than 70 patients for not following his rules.

Since the DEA raid, many of Nelson's patients have been unable to find doctors. Few physicians are trained in the complexities of pain control, and fewer still want to risk government second-guessing. Some of Nelson's patients have suffered acute narcotic-withdrawal symptoms, as he was unable to wean them gradually. Others, unable to cope with their pain, lost their jobs. They have staged demonstrations and press conferences in downtown Billings and mounted petition drives. As one of the few Montana doctors offering opioid therapy, Nelson was "like the Mother Teresa of medicine," says Jeannie Huntley, a marketing consultant who suffered brain and neck injuries from a car crash.

No one knows yet if any of Nelson's patients may have overdosed or illegally sold their meds--and the DEA is keeping mum. But even if he is eventually absolved, the Montana native plans to close his practice. "We thought we were doing everything just about right," he says. "But now a whole bunch of people are sitting out there hurting like hell."

"I'm watching people have their lives destroyed. There are patients who were functional under Dr. Nelson who now can't work or walk or even play with a two-year-old. But what is perhaps even more distressing is that their senators don't seem to think it's a problem. They are stonewalling; I am just dumbstruck by the lack of concern displayed by elected officials here." -

- Siobhan Reynolds, President: Pain Relief Network, in Billings, Montana; 2005

DEA Raid on Billings Doctor
Brings Pain Wars to Montana

04/29/2006 - The Drug Enforcement Administration's (DEA) war without quarter against what it sees as corrupt, pill-dealing physicians who are fueling a crisis in prescription drug abuse came to Montana last month. But with the raid on Billings physician Dr. Richard A. Nelson, who has been treating patients with opioids for chronic pain from cancer, arthritis, and other conditions, that all-too-familiar narrative has been challenged. An uproar that has yet to die down has gotten the attention of local media and at least one US senator as patients complain bitterly of being left in the lurch and national pain advocates arrived to press for justice for Dr. Nelson and his patients alike.

The uproar began on April 20, when DEA agents arrived at Nelson's West End office and seized his medical records and prescribing certificate. The DEA did not tell Nelson at the time why he was being raided, except to say that agents served an "administrative inspection warrant." Nelson was not arrested or charged with any offense, although that could be coming. The agency was still keeping mum this week, with Denver regional DEA spokesperson Karen Flowers telling DRCNet only that "this is an ongoing investigation."

Nelson, who has been practicing medicine in Billings since the 1970s, has a spotless record with the state medical board. He does not prescribe the controversial but medically accepted mega-doses of opioids that have triggered DEA investigations of other pain treatment physicians. But two of his patients reportedly died from drug-related causes in the last year, perhaps drawing the interest of the DEA. Nelson's practice remains open, and the DEA returned his files 10 days later, but he now cannot prescribe the medications needed by his chronic pain patients. The practice limps along under the cloud of the DEA raid.

While Nelson and his newly hired legal team wait to see what the DEA will do next, some 75 of his patients have been left out in the cold. Without Dr. Nelson, said patient Glen Wilkinson, Billings pain patients are finding adequate pain treatment hard to come by. "I ended up with Dr. Nelson as a last resort," said Wilkinson, who suffers from chronic pain related to two herniated and nine broken discs in his spinal column. "I had no place else to go. He's a good, honest doctor, but now I am being denied medical care based on my affiliation with him. My primary care physician told me he wouldn't see me again after I went to Dr. Nelson."

Wayne Nott, a retired rock quarry worker from Bridger suffering from a variety of painful complaints, including arthritis, multiple lipomas, and varicose veins who also lives with a titanium plate in his neck, is another patient of Dr. Nelson's who is having trouble finding a doctor to treat him. He told DRCNet he traveled more than a hundred miles to go to an appointment with a doctor who had agreed to see him, but when he arrived he was turned away.

"When I got to the doctor's office and told them I had an appointment, the receptionist asked for my name, then told me 'You did have an appointment, but you don't now.' She told me she got a phone call 10 minutes before I arrived saying not to treat any patients from Dr. Nelson's office. When I asked her who had told them that, she wouldn't say, but I know it must have been the DEA," Nott said.

"She told me I had to leave the building," said Nott. "She acted like I was some kind of psycho. People think that people who went to Dr. Nelson are junkies. I'm no junkie. I hate to even take the stuff I'm taking, but I have to for my chronic pain."

The physician in question, Dr. Ahmed Madi of Roundup, refused Thursday to discuss his reasons for turning Nott away. "I'm not interested, thank you very much. Bye," was his response to a DRCNet inquiry.

Nott has related his account of his encounter with Dr. Madi's office in a deposition provided to Dr. Nelson. He has also since managed to find a doctor to care for him, but in a telling indication of the atmosphere of fear and intimidation created by the DEA raid on Dr. Nelson, he asked that that doctor not be publicly named.

"This is horrible, I don't know how it could get any worse," said Dr. Nelson's wife, Jerrie Lynn, an acupuncturist who shares her husband's practice. "This is just unbelievably sad for the patients. The DEA is telling doctors not to see our patients," she charged, "and telling drug stores not to fill our prescriptions."

While patients who spoke with DRCNet backed Ms. Nelson's charge that the DEA is intimidating physicians and pharmacies, with some saying local doctors told them as much, it is a difficult charge to prove. DEA spokeswoman Flowers flatly denied it. "Absolutely not," she said. "That's false. If these people have medical problems, they should seek medical help. The medical community is obligated to help people who are sick."

Several patients told DRCNet St. Vincent Healthcare had turned them away, but the hospital denied both being told not to treat Dr. Nelson's patients and that it was turning them away. "St. Vincent Healthcare assesses and treats all patients on an individual basis. We follow guidelines and protocols for treatment based on established criteria. There is no policy or practice to refuse care to any of Dr. Nelson's patients," said Nancy Kallern, vice-president for patient affairs. "No," the hospital has not received notice from any agency advising it not to treat Dr. Nelson's patients, she told DRCNet.

"I have no reason to believe those claims are false, but the problem is in confirming it," said Siobhan Reynolds, executive director of the pain patients and physicians advocacy group the Pain Relief Network (PRN), who traveled to Billings last week to meet with Dr. Nelson and his patients. "Every time a doctor says this to a patient, they also say 'You didn't hear that from me.' The intimidation is complete," she said.

"Everyone is getting into the game," Reynolds continued. "Pharmacies are turning down Dr. Nelson's non-controlled scripts and insurance companies are declaring the doctor's demise, despite the fact Dr. Nelson is still in possession of an unblemished record with Montana's Board of Medical Examiners and is still practicing."

Typically in cases where physicians are accused of prescription wrongdoing, they are left dangling in the wind while DEA agents and prosecutors use their access to the media to paint a one-sided picture of pill-mills and Dr. Feelgoods. Reynolds was determined not to let that happen in Billings, and her strategy has paid off -- at least in public relations terms. In the last two weeks, the Billings Gazette has run at least three stories on the raid and its consequences, with titles such as "In Search of Relief: Pain Sufferers Caught in Medical Controversy" and "DEA Accused of Targeting Pain Doctors."

The third article was provoked by a very unusual event in Billings. Last Friday, after letters to US Senators Max Baucus (D) and Conrad Burns (R) were ignored, Reynolds and three dozen patients went to Baucus' Billings office to seek a meeting after his office turned down a request for a meeting the previous day. Standing outside the building until a staffer agreed to meet with them, they protested the DEA's nationwide pattern of going after pain doctors and its local impact, and demanded their representatives do something about it. "We want him to call for and help organize a Senate Judiciary Committee hearing on this issue," said Reynolds. "We want to see an investigation into what the DEA has been doing, and we need the subpoena power of the Senate to get behind the veil and find out what is going on."

"The feds and the state authorities can't both be responsible for the regulation of Montana's doctors," said patient Gregg Wilkinson during the protest. "The medical board says Nelson is impeccable, while these Washington bureaucrats are saying he's criminal. Somebody isn't telling the truth."

While Sen. Baucus was not present, office communications director Barrett Kaiser did come down to listen to patients' concerns and promised to relay them to the senator. But, he told the crowd, it is hard to say what Baucus will do. The senator supports the justice system and has a policy of not interfering with criminal investigations or legal policies, Kaiser said.

It remains unclear what action, if any, Baucus will take. Kaiser failed to respond to any of DRCNet's four calls seeking comment on the matter this week, and the office has made no other public remarks on the issue. "Senator Baucus stonewalled us," said Wilkinson. "Thirty-five people marched to his office, but he won't even dignify us with an answer."

"I'm watching people have their lives destroyed," said Reynolds. "There are patients who were functional under Dr. Nelson who now can't work or walk or even play with a two-year-old. The implications of this for these people are staggering. It is mind-boggling, but what is perhaps even more distressing is that their senators don't seem to think it's a problem," said Reynolds. "They are stonewalling," she told DRCNet. "I am just dumbstruck by the lack of concern displayed by elected officials here." Update: Late Thursday Sen. Baucus responded -- sort of -- in a letter to Reynolds. Baucus reiterated his "policy of not interfering with criminal investigations" and did not address the larger question of the DEA's aggressive behavior or the call for hearings in the Senate. But in a nice constituent service touch, he did contact the Deering Clinic in Billings on the patients' behalf, which "has given assurance that all patients will be afforded the opportunity to be assessed by their staff for a continued pain management care plan."

While that pledge is no guarantee of adequate opioid treatment for Dr. Nelson's patients, the Pain Relief Network will be watching closely, said Reynolds. "We will be overseeing the care of these patients and will be providing the clinic with expert advice in the event they fail to treat patients appropriately."

And while Sen. Baucus did not immediately acknowledge demands for a congressional look at the broader issues involved, his response was a first, said Reynolds. "This is a major step in the right direction. It's the first time a US senator has acknowledged the humanity of people in pain," she said.

While Dr. Nelson has the support of his patients, his colleagues in the medical profession have stayed largely silent or have been critical. The head of the Montana Medical Association, Dr. Joan McMahon of Lewistown, professed to be unfamiliar with the case and declined comment, saying only that "physicians have to follow DEA regulations."

Dr. Bill Rosen, a specialist in physical medicine and rehabilitation at the Deaconness Billings Clinic scoffed at the use of opioids as pain medications. "Narcotics have never been shown to heal anything," he told the Billings Gazette. "All you're doing is putting a Band-Aid on a wound that will never heal." While opioids may be appropriate in limited cases, he said, doctors are too quick to prescribe them for patients who could be helped in other ways. "People come in and tell me they are disabled by their pain," Rosen said. "I say you are disabled from your inability to cope with your pain."

Dr. Joseph Talley, a North Carolina physician whose practice was shut down by the state, found opioids useful for patients, but warned that doctors around Billings may decline to treat Dr. Nelson's patients with them for fear of becoming a magnet for patients and ultimately the next target for the DEA. "An opioid prescriber will be swamped with patients, good and sinister, from near and far," he told DRCNet. "As soon as the word gets out that a doctor will treat pain in adequate doses (which eliminates most doctors who prescribe at all) and will do so without making patients feel like dirty criminals (which eliminates all but a very tiny few of those remaining), the practice of those very few doctors will change drastically, and it will take on a form upon which the DEA can capitalize. He will have cars with out-of-state plates, desperate patients who couldn't get an appointment milling around his door, and when he treats one desperate patient, he is likely to get 10 desperate calls from her friends, neighbors, and relatives wanting help themselves," Talley said.

Unlike other prominent cases of physicians under the federal gun, Dr. Nelson was not prescribing massive amounts of opioids to patients, said his wife. "He doesn't really go outside the guidelines," she said. "He would prescribe maintenance doses and other prescriptions, but not the really high doses."

"The DEA needs to be held accountable -- at the very least it should be paying the medical bills for these people who have been adversely affected," said Nelson. "People can't function without their pain medications. Some have had to quit their jobs. One of our patients now has to have a person come in and care for him. And they are being treated like criminals when they go to the hospitals in search of relief."

In the meantime, it appears that Billings-area physicians are already aware of Dr. Talley's lesson and are staying away from opioids and patients who need them. "I was surviving on what Dr. Nelson gave me," said Nott. "Now all I can do is lay in bed all day."

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