Pubdate: Sun, 30 Nov 2003
Source: Mobile Register (AL)
Copyright: 2003 Mobile Register.
Contact:  http://www.al.com/mobileregister/today/
Details: http://www.mapinc.org/media/269
Author: Ronald Fraser

WAR AGAINST LEGAL DRUGS

The very same federal Drug Enforcement Agency that has repeatedly failed to 
slow the flow of illegal cocaine from abroad is now waging -- with help 
from its state partners -- an alarmingly successful war against legal 
prescription drugs here at home.

Problem is, the tactics used to keep these drugs off the black market have 
a nasty side-effect: Many terrified hometown physicians no longer give 15 
million Americans struggling with chronic pain the medicines they need.

In 2002, according to Dr. Joel Hochman, director of the National Foundation 
for the Treatment of Pain, the DEA investigated 622 physicians and brought 
charges against 586. In 426 cases, medical licenses were revoked "for cause."

"If the DEA continues as at present, there won't be any doctors writing 
opioid prescriptions in two more years," Hochman said. (Opioids, like 
OxyContin, are highly effective painkillers made from either opium or 
synthetics with the properties of opiate narcotics.)

Some observers say that the Alabama Board of Medical Examiners' 2001 
decision to revoke the medical license of Dr. Pascual Herrera Jr. of 
Gadsden, after three of his patients died of OxyContin overdoses, reflects 
a "drug war mentality" that too quickly blames doctors for the actions of 
their patients.

State and federal agents justify their actions as a response to DEA reports 
that "Alabama continues to see an increase in diverted pharmaceuticals 
across the state, and OxyContin is still the No. 1 abused drug." In 2000, 
Alabama was ranked 11th nationally for the number of OxyContin 
prescriptions written per capita.

It is true that some pain patients do sell their pills on the black market. 
Others overdose by mixing prescription medicines with other drugs and die. 
And perhaps some physicians knowingly take part in these illegal schemes.

But most doctors under attack, claims Hochman, are not deliberately abusing 
their professional responsibilities. They simply need better pain control 
training and office management skills.

His solution is for DEA, state regulatory agencies and state medical boards 
to work with -- rather than against -- the nation's 5,000 doctors 
practicing chronic opioid therapy.

"To be a competent physician," says Hochman, "every doctor in the United 
States needs to be adequately trained -- and most are not -- in the 
management of intractable pain. Law enforcement and physicians must work 
together to separate the sheep from the wolves and to identify and 
prosecute the small number of prescription abusers.

"Targeting the physician only drives legitimate pain patients into deeper 
despair, terminal hopelessness and into the black market for relief -- as 
in the case of Rush Limbaugh."

This heavy-handed approach is a three-part recipe for disaster:

- --Abandoned patients.

A pain practice might have 200 to 500 patients. As doctors lose their 
licenses, the number of abandoned patients will go up and all pain 
sufferers will have a harder time finding the care they need.

Where will abandoned pain patients find relief when other doctors in town 
are "narcophobic"? Many will turn to illegal channels, meaning these law 
enforcement tactics will actually create new customers for the same black 
market in drugs they claim to be dismantling.

- --Fearful doctors.

To avoid trouble, fewer physicians are likely to start new pain care practices.

Signs already appearing in doctors' offices read "Do not ask me to refill 
pain medications" and "Don't ask for opioids," as doctors adopt a 
cover-my-rear medical ethic that ignores their patients' welfare.

Even nursing home care is being harmed. Until outside pain consultants step 
in, terminally ill nursing home patients may not get the pain control 
medicines they need.

Staff physicians will be too afraid of the "drug warriors" to do their jobs.

- --Government intrusion.

Despite surveys that show seven of 10 Americans want their doctors, not the 
government, to decide what medical treatment they will receive, aggressive 
state and federal law enforcement tactics are bullying the medical 
community to under treat Americans with severe pain.

Here is how Dr. Jane Orient, director of the Association of American 
Physicians and Surgeons, sums up the situation: "Throughout the U.S. 
physicians are being threatened, impoverished, delicensed and imprisoned 
for prescribing in good faith with the intention of relieving pain. Law 
enforcement agents are using deceitful tactics to snare doctors, and 
prosecutors manipulate the legal system to frighten doctors who might be 
willing to testify on behalf of the wrongly accused doctors."

This year, federal taxpayers, including folks living in Alabama, will give 
DEA about $120 million to target doctors who aggressively use legal drugs 
to ease pain.

I wonder if these taxpayers, especially those suffering from chronic pain 
themselves, think this is money well spent.

Ronald Fraser, Ph.D., writes on public policy issues for the DKT Liberty 
Project, a Washington-based civil liberties organization.
- ---
MAP posted-by: Larry Stevens