Silent Until Today...

(Times Letter Follows)

Dec 2004

Dear Mr. Okrent,

I have written your office on several other occasions and have not received a reply. Following the Times' failure to cover the criminal trial of Dr. William Hurwitz and the pain movement that is being crushed by the United States government, I felt that I had to voice my complaint again and request a meeting with you.

I supplied Adam Liptak with a letter from 6 former presidents of the American Pain Society denouncing the testimony of the government's key expert witness against Dr. Hurwitz. The language could not have been stronger, an astonishing political development-that has again, gone unreported.

I have spoken to several reporters at the Times who made it clear that the paper was aware of the trial and of the other cases that PRN is supporting, we were yet again on the front page of the Washington Post when Dr. Hurwitz was convicted, the DEA withdrew its FAQ document and has since openly intimidated the medical community with a new statement of the law-the intimidation acknowleged by the AMA! and still nothing from the New York Times.

Celebrex and Vioxx have been shown to be tremendously dangerous and have been withdrawn from the market while opioids are nontoxic to major organ systems but their availability is actively suppressed by the US Department of Justice - we have a CSA that judges drugs according to law enforcement notions rather than scientific ones, and still the New York Times cannot find the story.

Patients and doctors are intimidated. Families are being ruined. Physicians are being required to act as policemen in the doctor patient relationship-the DEA says that doctors acting in good faith have nothing to fear and the SAME DAY that Tandy announces this "reassuring" position in USA Today, the US Attorney prosecuting Hurwitz asks the judge to leave the good faith instruction out of his charges to the jury which this unapologetically biased judge did. Still nothing.

Dr. Hurwitz had his 2 million dollar bond revoked and was thrown in jail immediately - someone who could not again commit the crime he had been convicted of - and still nothing.

What, Mr. Okrent, does it take to persuade the New York Times to cover this story?

I live in New York City and will be available to meet at your convenience. Given the fact that your paper looked at the ethical problems surrounding Barry Meier's reporting and gave yourselves a clean bill of health, I would have thought you would be eager to avoid any more misunderstandings regarding your coverage of the pain issue. I must say that I am shocked by your paper's failure to cover this story.

Thank You for Your Prompt Attention to This Matter,

Siobhan Reynolds
Family Member of a Chronic Pain Patient
Pain Relief Network
'Standing up for patients in pain and the doctors who treat them'
(212) 873-5848
(212) 873-6755 fax

THE TIMES Response:

1/5/05 - Dear Siobhan Reynolds,

Because you mentioned Adam Liptak, I was able to ask him about his decision not to cover the Hurwitz trial. But as you have apparently spoken with or tried to reach many people at The Times, I really can't give you a persuasive answer as to why the paper hasn't covered the PRN. If you would send me a summary indicating whom you have approached and what the response was, I'd be able to look into it with some chance of finding out the answer.

You'll note that I do not respond to your urging that The Times cover the story; that's because my job is to criticize what's in the paper; I have no role in determining coverage. But if I can get a sense of why The Times has failed to cover the story, it could at least enable me to address that part of the equation.

Yours sincerely,

Daniel Okrent
Public Editor

N.B. Any opinions expressed here, unless otherwise attributed, are solely my own

Mr. Okrent,

Thank you for your response. I dont think that polling the individual reporters will be helpful. The problem seems to stem from the Times' failure to fully account for the wrong-headedness of its reporting on this issue when Barry Meier was covering it. Law enforcement throughout the United States has prevailed upon otherwise level headed reporters to trumpet a drug scare regarding Oxycontin, much to the grave detriment of patients in pain, their families, and the doctors who had been treating them. This drug scare precipitated a spate of prosecutions which can only be characterized as a witchhunt. Witchhunts are terrible things, Mr. Okrent, and they must be exposed.

When you have a witchhunt occur on a national scale as we have here - and the inflammatory aspersions are cast by the government - exciting the raw nerves exposed by the terror attacks of 2001 - the damage done is truly cataclysmic.

The Orlando Sentinel apologized for the role it played here but the Times read its ethical mandate narrowly and found that Meier's reporting had been accurate. Despite giving yourselves a clean bill of health, your paper then ceased reporting the story all together.

The complaint, at least from PRN and the people in pain we represent, isn't that Meier's reporting was inaccurate like the Sentinel's was, it is that it was premised on assumptions which themselves are terribly prejudiced and which are wholly dismissive of the fundamental legitimacy of our claim that we merit treatment for our disease-pain.

Meier also simply refused to face the fact (supported by the wealth of the literature) that people in pain do not get iatrogenically addicted to opioids. He doggedly held to his view that these meds are "highly addictive" when the studies show that they are not.

So if you wanted to re-approach the problem from an ethical standpoint, I suppose you could take another look at Meier's reporting in light of the fact that it was self-serving to a degree not befitting a national reporter. And if that would get us to the point where the reporters at the Times would feel free to investigate what we are telling them, in an open and unprejudiced fashion, then by all means start here.

The main thing is to get the Times moving on our story. Every day that you dont tell it is a day that the patients are being destroyed and our doctors are being incarcerated and intimidated.

We are calling for a US Commission on Pain and a thorough examination of the methods employed by the government in procuring all these wrongful convictions. Until the people are made aware of what is happening to ill Americans in pain, on our soil, we will not be able to move the Congress to protect us from the Executive branch. The press' role (and therefore the Times' role) in the proper functioning of our democracy is well understood and is, I trust, a subject of interest to you as public editor.

Thank you,

Dear Mr. Okrent,

In my previous communication I mentioned that Mr. Meier's articles and book were based on the false premise that opioid analgesics are highly addictive when used in the treatment of chronic pain. I mentioned scientific literature that demonstrates that this is in fact not the case.

The fact that Mr. Meier overlooked this widely available scientific evidence in his zeal to participate in a government generated drug panic is understandable as human error. The fact that he has been aware of this evidence for more than a year, but refuses to address its implications, represents a breach of his, and your newspaper's obligations to its readers and the general public. The American people continue to be misinformed and injured by this ongoing ethical lapse.

I have pasted the relevant citations, along with a synopsis of each.

These surveys provide evidence that addiction is exceedingly rare during long-term opioid treatment of cancer pain and does not commonly occur among patients with no history of abuse who receive opioids for other medical indications.

Siobhan Reynolds

  • Friedman DP. Perspectives on the medical use of drugs of abuse. J Pain Symptom Manage 1990; 5(1 Suppl):S2-5.

    The treatment of severe pain requires the use of potent opioid analgesic medications. Many patients with opioid sensitive pain are being undermedicated. This results in increased morbidity and needless suffering. The most important reason for this undertreatment is the fear of addiction engendered by opioids, a fear that is greatly out of proportion to the real risk. The risk of addiction is greatly overestimated in part because many people do not understand the distinctions between drug abuse and drug addiction, on the one hand, and physical dependence and tolerance, on the other. Dependence and tolerance are virtually inevitable outcomes of long-term opioid use, but they are neither sufficient to cause addiction nor the equivalent of it. Indeed, the evidence shows that only a tiny fraction of patients treated with opioids become addicted. There is little risk of addiction for those patients receiving properly administered opioids for pain.

  • Medina JL, Diamond S. Drug dependency in patients with chronic headaches. Headache 1977; 17: 12-14.

    This survey of patients treated at a large headache center during 11 months could only identify three problem cases (two codeine and one propoxyphene abuser) among the 2,369 patients who had access to opioid analgesics.

  • Kanner RM, Foley K. Patterns of narcotic drug use in a cancer pain clinic. Ann NY Acad Science 1981; 362: 161-172.

    This analysis of the patterns of drug intake in cancer patients receiving chronic opioids suggests that the medical use of opioids rarely leads to drug abuse or to iatrogenic opioid addiction.

  • Schug SA, Zech D, Grond S, Jung H, Meuser T, Stobbe B. A long-term survey of morphine in cancer pain patients. J Pain Symptom Manage 1992;7:259-66.

    This study identified one case of substance abuse among 550 cancer patients who experienced pain and were treated with morphine for a total of 22,525 treatment days. Physical dependence posed no practical problem in discontinuation of morphine treatment. Long-term opioid intake and development of tolerance did not appear to be linked; an increase in morphine dosage was most often explained by progression of the terminal disease.

  • Perry S, Heidrich G. Management of pain during debridement: a survey of U.S. burn units. Pain 1982; 13:267-280.

    In a survey of burn facilities in the US, 181 staff members from 93 burn units were asked how many cases of actual iatrogenic addiction could be documented following the administration of narcotics for pain control in burned adults and children. Respondents with an average of 6 years of experience caring for at least 10,000 hospitalized burn patients found no case of addiction in patients treated for burn pain.

  • Portenoy RK, Foley KM. Chronic use of opioid analgesics in nonmalignant pain: Report of 38 cases. Pain 1986; 25: 171-186.

    38 patients were maintained on opioids for severe, chronic noncancer pain; half received opioids for four or more years, and six of these were treated for more than seven years. About 60% of the 38 patients reported that their pain was eliminated or at least reduced to a tolerable level. The therapy became problematic in only two patients, who both had a history of drug abuse. The authors provide guidelines for monitoring patients requiring opioid maintenance therapy.

  • Zenz M, Strumpf M, Tryba M. Long-term oral opioid therapy in patients with chronic nonmalignant pain. J Pain Symptom Manage 1992; 7: 69-77.

    This large survey described 100 patients with diverse pain syndromes who received dihydrocodeine, buprenorphine, or morphine for prolonged periods. More than half of these patients maintained greater than 50% analgesia for at least one month and performance status increased overall, with the largest improvement observed among those with the greatest relief of pain. No incidents were reported of serious toxicity or drug-related behaviors suggestive of addiction or abuse.

  • Moulin DE, et al. Randomized trial of oral morphine for chronic noncancer pain. Lancet 1996; 347: 143-147.

    This study used a cross-over design to compare the opioid against a placebo (benztropine) to ensure blinding of the therapy. The study evaluated a broad range of outcomes related to subjective effects and function. The results demonstrated a significant reduction in pain during morphine therapy, without change in physical or psychological functioning, and without evidence of psychological dependence or aberrant drug-related behavior.

  • Brookoff D, Palomano R. Treating sickle cell pain like cancer pain. Ann Intern Med 1992; 116: 364-368.

    In this survey, patients treated for sickle cell pain at a university-based clinic were prescribed opioids following the model based on the treatment of cancer pain. During a two-year follow-up period, emergency room visits declined by 67 percent and hospital admissions decreased by 44 percent. No increase in opioid abuse was reported.

  • Chapman CR, Hill HF. Prolonged morphine self-administration and addiction liability: evaluation of two theories in a bone marrow transplant unit. Cancer 1989; 63: 1636-1644.

    Using data obtained from patients in a bone marrow transplant unit, this study examined addictive behavior in patients who self-administered intravenous morphine in comparison with patients who received the drug via routine staff-controlled continuous infusion procedures. Self-administering patients used significantly less morphine than controls and still achieved the same amount of pain control; moreover, they terminated drug use sooner than controls. The results support the assumption that self-administration of opioids in a medical setting does not put patients at risk for over-medication or addiction.

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