The Federal Controlled Substances Act (CSA) does not require that physicians police their patients -- at least the United States Congress did not intend such a thing when it was drafted. Moreover, when the Congress enacted the CSA, it intended that the law would not affect the practice of medicine, and would instead exempt physicians from its provisions, as long as physicians prescribed "in the course of their professional practices." The CSA, as applied to physicians, would only allow the pursuit of those rare doctors who prescribed drugs in a wholesale fashion, charging by the prescription or on the street corner. It was never intended to regulate the day-in and day-out practice of medicine. We find ourselves victims of unintended consequences.

The most recent collaborative effort by the DEA and academic pain medicine-the "FAQ document" illustrates the Brave New World reality of the Drug Enforcement Administration's regulation of medical practice. By articulating the intrusion of the "principle of balance" into the physician's office, i.e., balancing law enforcement's concerns with medicine's, medicine has revealed that it has taken on the imperatives of law enforcement, in absolute conflict with medicine's primary ethical obligation, that physicians set the interests of their patients ahead of all others' interests.

The Geneva Conventions preserve the humane treatment of persons during armed conflict by requiring that physicians behave ethically, and that they shall not be "compelled to carry out tasks that are not compatible with their humanitarian mission" nor be "compelled to refrain from acts required by medical ethics."* Certainly no less ought to be expected from our physicians and government here at home, during a time of at least domestic peace. But medicine's adoption of the "principle of balance" has mixed and confused the very different roles properly played by medicine and law enforcement, and it has done so with deadly consequences for patients in pain.

Fear of prosecution and massive political pressure have caused academic pain medicine to confuse patient compliance with the outright coercion of patients; the slightest discrepancy between the manner in which a medication is prescribed and the way a patient takes his medication is characterized as "drug abuse" in the "FAQ document." A single such incident of "abuse" is sanctionable by removal of all pain care. Because of this sort of reasoning, patients are treated as presumptive criminals by the few doctors who are still willing to prescribe. As an example, patients are required to allow DEA and other law enforcement agencies to view their private medical records in order to commence or to continue receiving ongoing opioid pain care. The entire "FAQ document", in fact, assumes carte blanche law enforcement access to patient's medical records.

Under these rules, patients in pain dare not tell their doctors the truth about any increase in their pain or they risk losing what little care they do get.

If a patient ever expresses a need for more pain medication, that request itself constitutes an "aberrant drug related behavior." It can hardly matter that the DEA's "FAQ document" says that a patient's requests for more medication "may reveal other potential explanations, including the possible effects of unrelieved pain", the cold hard truth is that such simple candor on a patient's part "could lead to...the decision to taper and discontinue treatment." **

From the patient's point of view, the prospect of losing their pain care outright is reason enough to control the risk by not asking for the medications they need in order to lead a productive life. Jobs are lost, homes foreclosed, children taken away, and the person in pain, essentially medically abandoned inside of medical practice, struggles with the urge to end the pain through suicide. Since our government does not record suicides resulting from untreated pain, we cannot know how many of these unfortunate people eventually succumb.

By thinking we could regulate medicines with federal criminal law and not, thereby, the practice of medicine, we have, as a society, made a colossal error. The Founding Fathers gave a great deal of thought to the structure of the government of the United States of America, giving only certain limited powers to the federal government, reserving all others to the sovereign states. This was done specifically to protect us from the imposition of oppressive central authority, exactly what we, the people, have suffered here in spades.

The regulation of medicine in the states is protective of medicine and therefore of patients, and needs to be respected by us all.

We are calling upon the Congress to allow the American people to tell our side of the story and to defund the United States Department of Justice in its pursuit of medical professionals who treat pain.


Siobhan Reynolds
Family Member of a Chronic Pain Patient
Pain Relief Network
"Standing up for patients in pain and the doctors who treat them."

* Human Rights Protocol Additional to the Geneva Conventions.
Part 3, Articles 9&10.

** DEA "FAQ document" Section 20.

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