Pubdate: Sun, 05 Feb 2006
Source: Boston Globe (MA)
Copyright: 2006 Globe Newspaper Company
Contact:  http://www.boston.com/globe/
Details: http://www.mapinc.org/media/52
Referenced: John Tierney's column 
http://www.mapinc.org/drugnews/v06/n000/a016.html 
http://www.mapinc.org/drugnews/v06/n000/a015.html 
http://www.mapinc.org/drugnews/v06/n000/a016.html
Bookmark: http://www.mapinc.org/drugnews/people/Paey (Richard Paey)
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

PRESCRIPTION FOR PAIN

'PAIN-KILLER" is one of medicine's overblown promises. The pain is 
often eased and delayed, not killed. In chronic cases, it always 
comes back. The last thing that patients and doctors should be 
worrying about as they use these imperfect medications is an arrest 
for substance abuse by overzealous police.

But there are places in this country where patients and physicians do 
have to worry. The CBS program "60 Minutes" and New York Times 
columnist John Tierney have recently focused on the plight of a 
47-year-old father of three and law school graduate serving a 25-year 
drug-trafficking sentence in Florida.

Richard Paey has had to use a wheelchair since an auto accident 21 
years ago left him with screws in his spine and persistent pain. He 
also has multiple sclerosis. Despite three months of surveillance, 
police found no evidence he was selling any of his drugs, but a 
prosecutor still succeeded in convicting him on the grounds that he 
could not himself have used the 25 pills a day he was getting. Paey 
said he took that many pills, each of low dosage, to avoid higher- 
strength pills that could tempt drug abusers and draw the attention 
of the Drug Enforcement Administration. He is appealing his conviction.

Historically, doctors in the United States tended to under-medicate 
patients with chronic pain for fear they would become addicted. 
Improvements in medications and the development of the hospice model 
for treating terminal patients have led to better pain management. 
But doctors and patients in chronic but not terminal cases face 
increasing scrutiny when patients need repeated prescriptions for 
large quantities of controlled substances.

CBS interviewed Dr. Russell Portnoy, chairman of the department of 
pain medicine at Beth Israel Hospital in New York, who said, "There 
is a very deep concern on the part of the medical profession that the 
authorities don't know anything about pain medicine and are so afraid 
of prescription drug abuse that they tend to investigate or go after 
prescribers on the basis of very weak evidence."

In Boston, Dr. Carol Warfield, chairwoman of the department of 
anesthesia, critical care and pain medicine at Beth Israel Deaconess, 
and a professor at Harvard Medical School, said that to her knowledge 
there had been no recent cases in this state like Paey's. But she 
said that here, too, doctors work in fear of patients becoming 
addicted and of themselves suffering legal sanctions for their 
prescribing practices.

Martha Coakley, district attorney for Middlesex County, said she does 
not think that overzealous prosecution of prescription drug abuse is 
a problem in this state. Speaking of her own office, she said, "We 
would stop short of micro-managing" pain treatment. But she said 
there is a problem of prescription drug users becoming addicted to 
substances like OxyContin. Coakley is right that prescription drug 
abuse is a problem, just as the use of methamphetamines, heroin, and 
cocaine is. But patients will suffer needlessly if prosecutors and 
the DEA do not fine-tune their investigations of suspected prescription abuse.
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