Pubdate: Fri, 22 Apr 2011
Source: Minneapolis Star-Tribune (MN)
Copyright: 2011 Star Tribune
Contact: http://www.startribunecompany.com/143
Website: http://www.startribune.com
Details: http://www.mapinc.org/media/266

DRUG WAR SHOULDN'T CLAIM NEW VICTIMS

Inadequate pain treatment is a public health crisis,
too.

The latest battle in the war on drugs must not create a new and
innocent group of victims -- patients imprisoned by their own pain
because doctors are unwilling or unable to prescribe the powerful pain
medications that they need.

That is the risk of a well-intentioned but potentially detrimental
push by the Obama administration this week to rein in abuse of
prescription painkillers such as oxycodone, morphine and methadone.

Federal drug enforcement officials rightly called attention to the
scourge of crime and addiction that street use of opioid drugs cause.
This is a public health crisis.

But so is medicine's long history of undertreating patients' pain.
Racial disparities in adequate pain treatment and access to these
medications is another shameful, under-the-radar facet of this issue.

The Obama administration didn't do enough to acknowledge these
critical issues as officials rolled out their initiative against drug
abuse this week.

The effort will increase prescription painkiller oversight at the
state and federal level, require new educational materials from drug
manufacturers and promote public awareness of proper drug disposal.

These efforts are welcome. But officials need to ensure the initiative
does not have an unwelcome consequence: a chilling effect on
physicians' willingness to write prescriptions for these drugs or
control pain with higher doses.

Many doctors are already skittish about prescribing powerful
painkillers for outpatient use because of the oversight that already
exists. That's only going to be exacerbated by the feds' tough talk
this week.

Also troubling: officials' one-size-fits-all legislative solution.
Instead of focusing on the tiny percentage of doctors who run
so-called "pill mills," officials are eyeing a new law that would
require physicians to undergo additional training before they can
prescribe these drugs.

Is another hurdle really necessary for the majority of responsible
providers?

The initiative "really could have a chilling effect ... and could
potentially get in the way of people who do need serious pain
control," said Art Caplan, a bioethicist at the University of
Pennsylvania. "I've already heard doctors say, 'I don't want to
prescribe because I don't want to attract DEA or police
attention."'

The DEA is the U.S. Drug Enforcement Administration, which regulates
the dispensing and prescribing of controlled substances.

Minnesota also uses a database to monitor use of painkillers and other
addictive drugs. This helps prevent abusers or drug dealers from
getting multiple prescriptions from different doctors.

Dr. Miles Belgrade, medical director of Fairview's Pain Management
Center, worries that the initiative will result in physicians
referring chronic pain patients to specialists. He said there aren't
enough such doctors to meet the need.

Conditions that can cause chronic pain include cancer, HIV/AIDS and
advanced heart disease.

Using these medications for pleasure is abuse. But so is not taking
advantage of them, especially the newest generation of such drugs,
which help provide continuous relief to those who are suffering.

The message from the Obama administration needed to better reflect
those unique risks and benefits.

Substance abuse is a real issue, but there is also a growing
population of people with life-limiting pain. Federal officials need
to ensure they don't focus on one health issue at the expense of the
other.  
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MAP posted-by: Richard Lake