Pubdate: Sat, 21 Jan 2006
Source: New York Times (NY)
Copyright: 2006 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: John Tierney
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

PARTY OF PAIN

As the baby boomers age, more and more Americans will either be
enduring chronic pain or taking care of someone in pain. The
Republican Party has been reaching out to them with a two-step plan:

1. Do not give patients medicine to ease their pain.

2. If they are in great pain and near death, do not let them put an
end to their misery.

The Republicans have been so determined to become the Pain Party that
they've brushed aside their traditional belief in states' rights. The
Bush administration wants lawyers in Washington and federal
prosecutors with no medical training to tell doctors how to treat patients.

As attorney general, John Ashcroft decided that Oregon's law allowing
physician-assisted suicide violated the federal Controlled Substances
Act because he didn't consider this use of drugs to be a "legitimate
medical purpose." Karen Tandy, the head of the Drug Enforcement
Administration, has been using this same legal theory to decree how
doctors should medicate patients with pain, and those who disagree
with her medical judgment can be sent to prison.

You know Republicans have lost their bearings when they need a lesson
in states' rights from Janet Reno, who considered the Oregon law when
she was attorney general. For the federal government to decide what
constituted legitimate medicine, she wrote, would wrongly "displace
the states as the primary regulators of the medical
profession."

The Supreme Court agreed with her this week in upholding the Oregon
law. In the majority opinion, Justice Anthony Kennedy said the federal
drug law did not empower the attorney general "to define general
standards of medical practice." It merely "bars doctors from using
their prescription-writing powers as a means to engage in illicit drug
dealing and trafficking as conventionally understood."

That's news to the D.E.A. and the federal prosecutors, who have gone
way beyond any "conventionally understood" idea of drug trafficking.
They've been prosecuting doctors for prescribing painkillers like
OxyContin, even where there's no evidence of any of the drugs being
resold on the streets. It doesn't matter that the doctor genuinely
believed that the patient needed the drugs and was not abusing them.
It doesn't matter that the patient was in pain.

No, doctors are now going to prison merely for prescribing more pain
pills than the D.E.A. and prosecutors deem a "legitimate medical
purpose." These drug warriors are not troubled by the enormous range
in the level of pain medication that different patients need.

They don't even seem to worry much about the potency of the pills,
just the number. They want enough pills of any dosage to make a good
photo at a press conference. In some cases, doctors have been too
careless or gullible, but those are offenses to be disciplined by
state medical authorities, not criminal courts.

Tandy claims that only a few corrupt doctors have anything to fear
from the D.E.A. She responded to a column of mine last year by saying
that her agency had investigated only 0.1 percent of the 600,000
doctors in the U.S. But she was far too modest. Most doctors, after
all, write few if any prescriptions for opioid painkillers.

The doctors who matter are the small number of specialists in pain
treatment who prescribe opioids. Ronald Libby, a professor of
political science at the University of North Florida, estimates that
17 percent of those doctors were investigated during one year by the
D.E.A., and an even greater number of others were investigated by
local and state authorities, typically in concert with the drug
agency. That means a pain specialist might have a one-in-three chance
of being investigated for prescribing opioids.

Faced with those odds, doctors are understandably afraid. As noted in
The New England Journal of Medicine this month, the D.E.A. has made
doctors reluctant to give opioids to desperately ill patients, even
when these drugs are the most effective pain treatment. The article
warned that a victory for the Bush administration in the Oregon case,
besides affecting terminally ill patients in Oregon, could cause
doctors across the country to "abandon patients and their families in
their moment of greatest need."

The Supreme Court's decision is a victory for patients and their
doctors - including, I hope, some of the ones in prison for violating
the federal legal theory that has now been rejected by the court. The
doctors should go free, and Republicans in the White House and
Congress should restrain the drug warriors who locked them up. When
this year's budget is drawn up, it's the D.E.A.'s turn to feel pain.
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MAP posted-by: Richard Lake