Pubdate: Tue, 26 Apr 2005
Source: News & Observer (NC)
Copyright: 2005 The News and Observer Publishing Company
Contact:  http://www.news-observer.com/
Details: http://www.mapinc.org/media/304
Author: Sarah Avery

TIGHTER DRUG LAW HOBBLES PATIENTS

Pain doctor calls effect 'immense'

The quarterly ride to her Chapel Hill doctor takes Karen Nelson more than an
hour from her home in Harnett County, and it's rough going all the way
because Nelson is in constant pain.

Now she has to make the trip monthly, tripling her misery.

Under guidelines recently proposed by the Drug Enforcement Administration,
Nelson and other pain sufferers must be seen every month by their doctors
before they can get a 30-day prescription for narcotic pain medications to
treat chronic conditions.

That change, among others proposed by the Bush administration, has raised an
uproar from pain sufferers and their doctors. They worry that the efforts to
stem illegal narcotic schemes are hurting legitimate users and reversing
hard-fought gains to treat chronic pain.

"It's going to affect me as far as taking away that little bit of quality of
life I have left," said Nelson, 46, who takes liquid morphine and uses a
narcotic skin patch to quell constant pain from a nerve disorder. "It's
another reminder of a life that's been changed."

By law, narcotics cannot be refilled like other medications, so the DEA
guidelines simply restate that requirement.

But it had been common practice, allowable under an earlier guide the DEA
published, for doctors to give stable, well-managed patients such as Nelson
prescriptions for several months at a time, future-dating the orders so
patients could fill only one 30-day supply at a time.

Dr. Sunil Dogra, a pain specialist at UNC-Chapel Hill, said the DEA's new
stance is burdening the hospital's pain clinic, filling the waiting room
with patients who now must make, and pay for, a monthly doctor visit where
one a quarter had sufficed.

"The impact is immense," Dogra said. "It's an economic impact, a time
impact."

Dr. Thomas Buchheit, co-director of Carolina Pain Consultants, said his
practice at Rex Healthcare in Raleigh is seeing nearly 300 more patients a
month since March, when pharmacies in the state began refusing to fill
future-dated prescriptions in compliance with the new DEA rules.

"For patients who are stable -- the 70-year-old woman with advanced spinal
disease or arthritis -- we didn't feel they needed to be seen every month,"
Buchheit said, noting that other patients do require monthly care.

Abuse is the concern

The doctors expect insurance carriers to see cost spikes, especially the
taxpayer-funded Medicare and Medicaid programs. Many pain patients are on
Medicare because they are older than 65, or their pain has rendered them
disabled and, as a result, eligible for Medicaid.

Increased costs in those programs comes at a time when the Bush
administration has proposed cuts to Medicaid and when the state, which pays
a portion of Medicaid costs, is facing another tight budget year.

But economics are not driving the DEA's new strictness. The agency's concern
is the diversion of legal medications to illegal uses. Drugs such as
morphine, OxyContin and methadone are widely used by doctors to treat the
estimated 50 million people suffering chronic pain, but they are also
popular among drug abusers.

The tension between legitimate and criminal uses of the drugs has been a
constant issue for doctors and pain sufferers. Because they can be
addictive, the drugs are tightly controlled by the DEA, which monitors how
doctors prescribe them, pharmacists dispense them and patients use them.

In recent years, however, pain sufferers fought for and won acknowledgment
that long-term use of narcotics was warranted for arthritis, spinal
injuries, nerve damage and other conditions. Doctors began to ease how they
prescribed them, emboldened by evidence that prolonged use for pain did not
create addicts.

But problems arose. In North Carolina, a rural doctor had his medical
license suspended in 2002 after a highly publicized case in which he was
accused of running a "pill mill" that led to the overdose deaths of some
patients. Just this month, a prominent Virginia pain doctor, William E.
Hurwitz, was sentenced to 25 years in prison for prescribing the drugs in
massive quantities.

Buchheit said he thinks some doctors were too liberal in their prescribing
practices, and a bit of retrenchment might be needed.

"Some nationally known experts taught this gospel that it was acceptable and
appropriate, and a patient right, to have as much narcotic as necessary to
treat pain," he said. "We now think it may help a lot of people, but it's
not appropriate for everyone, and you can't use unlimited doses for
everyone."

'A slap in the face'

But Dogra and others worry that the DEA's changes signal a retreat from some
of the best gains made for the therapeutic use of the drugs.

"The number of physicians who divert is less than 1 percent, and patients,
it's 2 or 3 percent," Dogra said. "I just think it's some stupid
administrative guy who is unaware of the impact this regulation is going to
have on the entire health care system."

The DEA quit taking public comments about the guidelines in March. A
spokeswoman for the agency in Washington, Rogene Waite, declined to answer
questions about the process and said she did not know when a decision would
be made.

Nelson said she wrote the DEA, U.S. Rep. Bob Etheridge, a Democrat from
Lillington, and North Carolina Republican Sens. Elizabeth Dole and Richard
Burr.

"I hit them all," she said. "I even so much as sent a letter to Bush. It's a
slap in the face that you're already suffering, then all of a sudden the
government thinks you're abusing drugs also."
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