Pubdate: Mon, 21 Feb 2005
Source: American Medical News (US)
Copyright: 2005 American Medical Association
Contact: http://www.ama-assn.org/apps/amednews/edlet.pl
Website: http://www.amednews.com/
Details: http://www.mapinc.org/media/1235
Author: Andis Robeznieks
Cited: US Drug Enforcement Administration http://www.dea.gov
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

ATTORNEYS GENERAL STEP INTO PAIN PRESCRIBING DEBATE

The group is asking the DEA not to impede "the legitimate practice of 
medicine," but the agency says it is not a barrier to care.

A new voice has joined the chorus claiming that recent actions by the U.S. 
Drug Enforcement Administration appear to impede the prescribing of 
controlled substances to treat pain.

The National Assn. of Attorneys General, in a Jan. 19 letter, called on DEA 
Administrator Karen P. Tandy to meet with representatives of the 
organization to "find ways to prevent abuse and diversion without 
infringing on the legitimate practice of medicine or exerting a chilling 
effect on the willingness of physicians to treat patients who are in pain."

The letter was signed by the attorneys general from 29 states and the 
District of Columbia. The effort was led by Oklahoma Attorney General and 
NAAG Past President W.A. Drew Edmondson, who said he was approaching the 
issue from a consumer-protection standpoint.

"If our consumers are not receiving what they need and want as health care 
consumers, then that's a problem for the attorney general," Edmondson said. 
"The new position of the DEA has at least the potential -- if not the 
actual effect -- of being a barrier to doctors prescribing the proper drugs 
for treating pain. I fully support efforts to combat diversion, but we have 
to find ways to combat diversion that does not impact on good patient care."

Edmondson said it appears that investigating physicians might be the new 
focus of DEA anti-diversion efforts, and he disagrees with that approach. 
"We should concentrate on drugs that are illegally on the streets and work 
backward from that to find out how they got illegally on the streets," he 
said. "It should not be the other way around looking at doctors."

In August 2004, after working for more than two years with experts in the 
field of pain medicine, the DEA released a frequently-asked-questions 
document on prescribing controlled substances for pain treatment that 
sought to balance physician concerns about effective treatment and law 
enforcement issues regarding diversion of prescription drugs. The DEA 
removed the document from its Web site in October 2004, and posted a notice 
in the Nov. 16 Federal Register stating that the document contained 
incorrect information. Some physicians said the new policy statement 
appeared to criminalize more prescribing activity.

Most Americans say they would prefer to die at home, free of pain and 
without unwanted medical intervention.

On Jan. 18, another notice was posted notifying the public that the agency 
was in the process of preparing another document and was seeking comments 
from physicians and other interested parties about what they wanted the 
document to include.

The NAAG letter expressed surprise that the DEA "apparently shifted its 
policy" from balancing medical and law enforcement concerns.

"We are concerned that state and federal policies are diverging with 
respect to the relative emphasis on ensuring the availability of 
prescription pain medications to those who need them," the letter stated.

DEA spokesman Rusty Payne denied there had been a shift in policy.

"DEA has not changed any policy related to this issue," Payne said in an 
e-mail. "The reason for taking down the FAQs was simply because there was 
some information that was incorrect. ... DEA has not changed its 
enforcement emphasis with respect to investigating physicians involved in 
the illegal prescribing of pharmaceutical narcotics."

He added that no meeting had been scheduled with the NAAG.

Most Americans die in a hospital or nursing home.

Attorney and pain medicine advocate Mary Baluss, the director of the Pain 
Law Initiative in Washington, D.C., said she cheered when she first saw the 
NAAG letter, but then her enthusiasm was dampened somewhat when she saw 
that attorneys general for 21 states had not signed the letter.

Edmondson, however, was satisfied with the signatures the letter received. 
"Getting all 50 to sign is pretty near impossible -- getting three 
attorneys in a room to agree on something is problematic," he said.

Edmondson's interest in pain treatment stems from his work promoting better 
end-of-life care.

He said that interest was sparked when he attended a bioethics program 
where he learned that most Americans would prefer to die at home with 
friends and family, free of pain and without unwanted medical intervention. 
Instead, he said, most Americans die in pain at a hospital or nursing home.

"I was thinking, 'What's wrong with this picture and what can I do about 
it?' " Edmonson said.

He formed an end-of-life care task force in Oklahoma and, while serving as 
the 2002-03 NAAG president, selected end-of-life care as the subject of his 
presidential initiative.

"There has been an increased focus, I believe, by medical licensing boards 
on the undertreatment of pain and, with the shift by the DEA, doctors are 
in a tough, tough position," Edmondson said. "Anything we can do to lessen 
that squeeze, I believe, is helpful, and that's the purpose of the letter 
to the DEA."

American Medical Association policy states that "physicians who 
appropriately prescribe and/or administer controlled substances to relieve 
intractable pain should not be subject to the burdens of excessive 
regulatory scrutiny, inappropriate disciplinary action or criminal prosecution."
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