Pubdate: Thu, 16 Aug 2007
Source: Washington Times (DC)
Copyright: 2007 News World Communications, Inc.
Author: Zachary David Skaggs
Note: Zachary David Skaggs is a fellow specializing in pharmaceutical 
policy at the Competitive Enterprise Institute.


Since 2000, the Drug Enforcement Administration has embarked on a 
muscular campaign against prescription painkiller abuse. It has 
utilized undercover investigations, SWAT raids, asset forfeiture, and 
high profile trials against "kingpin" doctors. These tactics should 
be familiar to anyone who has studied the drug war, but the results 
are a shocker. Prescription opioids have actually grown scarce.

To put it bluntly, the DEA has finally found a drug war it can win.

"Opiophobia" is a term that describes doctors' increasing 
unwillingness to prescribe opioid painkillers - a class of drugs that 
includes Vicodin and OxyContin - and especially high-dose opioids, to 
those in pain. This fear is rooted in the DEA's practice of jailing 
those doctors it deems are prescribing outside "legitimate medical standards."

Because pain doesn't show up on an MRI, doctors work together with 
their patients to achieve proper dosage. And, thanks to individual 
chemistry, pain level, drug tolerance, or typically, all three, 
patients vary tremendously in the number of milligrams they require. 
But when the only thing doctors know for certain is that prescribing 
large amounts of opioids endanger them, it is those suffering the 
worst who go undermedicated.

Call it "opiophobia," call it a "chilling effect," or simply, doctors 
behaving rationally, the result is the same: massive 
underprescription of opioids and radical undertreatment of pain. A 
Stanford study puts the number of undermedicated chronic pain 
patients at about 50 percent. According to the American Pain Society, 
fewer than 50 percent of cancer patients receive sufficient pain relief.

Retired Marine James Fernandez is a Gulf War vet, a helicopter 
copilot, and a longtime chronic pain sufferer. While injuries 
sustained during the Gulf War left him reliant on nearly a gram of 
OxyContin and MS Contin per day, it was the war on drugs that would ground him.

Following his return from Iraq, Mr. Fernandez was ping-ponged from 
one doctor to the next, none willing to prescribe at the dose 
necessary to treat his crippling pain. He reports one military 
physician even explicitly making mention of his fear of being 
"red-flagged" by the DEA. Under-medicated but still fighting for his 
right to pain relief, Mr. Fernandez describes his long-suffering, 
bed-ridden existence as "mostly miserable, most of the time."

Today, Mr. Fernandez's cause has been picked up by energetic 
advocates like Dr. Alex Deluca of the Pain Relief Network, but many 
are not so fortunate.

Take those treated with Vioxx, a popular alternative to opioids that 
rang up $2.5 billion in sales the year before its discontinuation in 
2004. To its credit, Vioxx treated pain, though not nearly as 
powerfully as opioids. But it was Vioxx's unfortunate side effect of 
causing heart attacks that led to its discontinuation, not its 
middling analgesic effect.

Today risk-averse doctors trot out a motley mixture of placebos, from 
anti-epileptics to tricyclic antidepressants. Risky spinal fusion 
surgery is performed 20,000 times each year, despite the New England 
Journal of Medicine finding "no acceptable evidence" of the 
procedure's efficacy.

But ineffective therapies and dangerous surgical interventions do not 
draw the DEA's eye - painkillers do.

Some patients attempt to skirt these problematic treatments, not 
because they've necessarily read the literature, but, more commonly, 
because they know what has worked for them. The medical community has 
come to regard them as "doctor shoppers," no different than junkies 
seeking a fix. The hardening of doctor attitudes against their 
patients represents another casualty of the DEA's campaign.

The DEA is so used to losing the drug war it has trouble 
understanding the effect its campaign is having. "To the million 
doctors who legitimately prescribe narcotics to relieve patients' 
suffering," counsels DEA Administrator Karen Tandy, "you have nothing to fear."

But doctors have very different incentives than drug dealers, 
including a wealth of options available to them that do not endanger 
their lives and livelihood. With doctors cutting back, pain patients 
- - unlike the abusers the DEA is trying to target - are running out of options.

This is the legacy of the drug war's lone success.

Zachary David Skaggs is a fellow specializing in pharmaceutical 
policy at the Competitive Enterprise Institute.
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MAP posted-by: Beth Wehrman