Pubdate: Sat, 23 Jul 2005
Source: New York Times (NY)
Copyright: 2005 The New York Times Company
Author: John Tierney


The current zeal for sending doctors to jail for writing painkiller
prescriptions may seem baffling, especially to the patients who relied
on the doctors for pain relief. But if you consider it from the
perspective of the agents raiding the doctors' offices, you can see a
certain logic.

During the war on drugs in the 1980's and 1990's, federal and local
agents risked their lives going after drug gangs on the streets. As
their budgets for drug enforcement soared, they arrested hundreds of
thousands of people annually and filled a quarter of American prison
cells with drug offenders.

But what did they have to show for it? Drugs remained as available as
ever on the streets - and actually got a lot cheaper. The street price
of heroin and cocaine dropped by more than half in the last two
decades. Dealers just went on dealing, not only lowering their prices
but also selling stronger, purer versions of heroin, cocaine and marijuana.

Given this record, and the pressure from Congress to show results,
it's understandable that the Drug Enforcement Administration and local
police departments hit on a new strategy: defining deviancy up.
Federal and local authorities shifted their focus to doctors and the
new scourge of OxyContin and similar painkillers, known generally as

As quarry for D.E.A. agents, doctors offered several advantages over
crack dealers. They were not armed. They were listed in the phone
book. They kept office hours and records of their transactions. And
unlike the typical crack dealer living with his mother, they had
valuable assets that could be seized and shared by the federal, state
and local agencies fighting the drug war.

I don't mean to suggest that the doctors were all blameless, or that
OxyContin wasn't being diverted to the black market and being abused.
But the problem wasn't nearly as bad as federal and local authorities
made it out to be.

The D.E.A. announced that in two years, there had been 464 OxyContin-
related deaths, but most of the victims had taken other drugs, too, so
the cause of death was uncertain. Ronald Libby, a political scientist
at the University of North Florida, notes that even that figure is a
minuscule fraction (0.00008 percent) of the number of OxyContin
prescriptions written, and that it's dwarfed by the more than 32,000
people who die in the same period from gastrointestinal bleeding from
other painkillers, like aspirin and ibuprofen.

The OxyContin crisis was fanned by sensationalized press coverage and
by popular fears that unsuspecting patients getting this painkiller
were being turned into dangerous addicts. While it's true that
chronic-pain patients taking opioids for a long time require higher
and higher doses, the drugs typically don't give them a high or
interfere with their lives. Instead, the drugs enable them to function.

Researchers have repeatedly found that very few patients taking
opioids have a hard time stopping once their pain goes away. The ones
who can't stop - the compulsive addicts - are typically people with a
history of abusing alcohol and other drugs.

But many doctors are now afraid to give painkillers to either kind of
patient. The D.E.A. tried reassuring them by working with pain-
management experts to produce a pamphlet setting out guidelines for
doctors who want to avoid investigation. But last fall, the agency
said it wasn't bound by the guidelines after all, and could
investigate even when it had no reason to suspect a doctor.

That shift prompted a letter from the attorneys general of 30 states,
who complained that patients were not getting proper pain relief
because the D.E.A. was confusing and scaring doctors.

The state officials warned that "we cannot cast a broad net over all
health care practitioners, hoping that a few criminals will be caught
while the other cases are thrown out."

If enough doctors are jailed or scared into not writing prescriptions,
it's conceivable that this drug war could have more impact than the
ones against heroin and cocaine - doctors, after all, are harder to
replace than crack dealers. But even if there's less OxyContin on the
street, is that worth the suffering of patients who can't get the
painkillers they need?

Maybe some OxyContin addicts would be helped, but consider the progress
the White House's drug-policy agency found last year in a field survey
on drug use in Cincinnati:

"Because diverted OxyContin is more expensive and difficult to
purchase," the agency reported, "users have switched to heroin." 
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