The DEA head says doctors who legitimately prescribe painkillers have nothing to fear. It was not the life sentence prosecutors sought, but for 59-year-old William Hurwitz, MD, the 25-year sentence he received April 14 may be just that. Some fear the federal prison time and $1 million fine may have a chilling effect on pain prescriptions. A jury in December 2004 convicted the McLean, Va.,-based pain specialist, who gained fame when "60 Minutes" told his story, of 50 of the 62 counts related to prescribing large amounts of opioids and other narcotics. [continues 283 words]
The Doctor Is Now Working To Rebuild His Practice Six years, four lawsuits and two arrests later, Frank Fisher, MD, is finally out from under the legal cloud that hovered over him since the opioid prescriptions he wrote for his patients in Anderson, Calif., attracted law enforcement's attention. The Shasta County Superior Court in late January dismissed three wrongful-death civil lawsuits pending against him. The dismissal marked the last legal hurdle that Dr. Fisher needed to overcome to begin clearing his name and rebuilding his practice. [continues 340 words]
The group is asking the DEA not to impede "the legitimate practice of medicine," but the agency says it is not a barrier to care. A new voice has joined the chorus claiming that recent actions by the U.S. Drug Enforcement Administration appear to impede the prescribing of controlled substances to treat pain. The National Assn. of Attorneys General, in a Jan. 19 letter, called on DEA Administrator Karen P. Tandy to meet with representatives of the organization to "find ways to prevent abuse and diversion without infringing on the legitimate practice of medicine or exerting a chilling effect on the willingness of physicians to treat patients who are in pain." [continues 761 words]
Pain Medicine Experts Seek Balance in Policies on Prescribing Controlled Substances. The U.S. Drug Enforcement Administration is preparing a document that will address its role as defined by the Controlled Substances Act. The DEA has invited physicians and others to submit comments on what they would like the document to address. According to the announcement, published in the Jan. 18 Federal Register, those interested have until March 21 to submit comments. The announcement was the latest in a series of notices about a frequently-asked-questions document on prescribing controlled substances for pain treatment that was posted on the DEA Web site in August 2004 and then withdrawn in October. [continues 244 words]
The American Medical Association will work with the Drug Enforcement Administration to address physician concerns that an interim policy statement published by the agency in November could interfere with the way doctors prescribe opioid analgesic medications to some patients. Doctors worry that the statement could make it illegal to write multiple pain medication prescriptions for a patient on the day of a visit and evaluation. Physicians also worry that they no longer could legally write directions for dispensing additional medication on future, specified dates. At the AMA's Interim Meeting in Atlanta this month, delegates called on the Association to support interpreting federal law in a way that would let doctors continue to write pain medication prescriptions for patients in need, while letting the government provide oversight and regulation to minimize risks to patients' health and safety. [end]
The Agency's "Clarification" Appears to Criminalize a Practice Now Taught in Pain Medicine Programs. What was once considered a feel-good document co-authored by U.S. Drug Enforcement Administration staff and pain medicine experts is now causing ill will, confusion and concern that relations between the agency and the medical community have taken a turn for the worse. The DEA wrote in the Nov. 16 Federal Register that a "frequently asked questions" document it co-authored with the University of Wisconsin Pain & Policy Studies Group and the Last Acts Partnership contained "misstatements." These included remarks on what could trigger an investigation and the appropriateness of writing multiple prescriptions on the same date. These items in particular have caused concern in the pain medicine community because they appear to reverse policies endorsed in the original document, which was taken off the DEA Web site in October. [continues 352 words]
To date, nine states have legalized medical use of the substance. Medical societies in three states are fighting to see November ballot initiatives dealing with marijuana go down in flames. The groups argue that the measures are bad for public health. Voters in Alaska, which legalized medical marijuana in 1998, will decide whether to decriminalize marijuana altogether for adults. In Oregon, voters face a question of whether to expand existing medical marijuana laws. And Montana voters will decide whether to legalize medical marijuana, which would make the state the 10th to do so. [continues 1097 words]
Prosecutors oppose legislation to allow doctors to examine evidence against doctors before an arrest is made. Stories of doctors being the subject of showcase arrests because of their prescribing volumes have made the medical community uncomfortable, but when two of these arrests occurred in the far northern California district of state Sen. Sam Aanestad, DDS, he decided to do something about it. Dr. Aanestad introduced the Medical Crimes: Investigations and Prosecutions bill endorsed by the California Medical Assn. The bill calls for a physician review of a doctor's prescribing patterns before an arrest is made and also for the timely return of any medical records seized during an investigation. =A0 [continues 578 words]
Physicians Say the Investigations Are Politically Motivated. California physician Philip Denney, MD, figures a complaint will be filed against him someday for recommending medical marijuana to patients. "They'll make something up sooner or later, and I'll have to deal with them," said Dr. Denney, who in February started a southern California practice dedicated to medical marijuana evaluations. Dr. Denney isn't alone in his belief. Other California physicians as well as at least one in Oregon who recommend medical marijuana say they are being persecuted by medical boards because of the practice. [continues 310 words]
This form of substance abuse is widespread, but continues to fall below the radar screen of most parents and many physicians. Experts always say inhalant abuse seems to stand in the shadow of other drug problems. It's not that the abuse -- often called sniffing or huffing -- doesn't happen. It's that there is less awareness both about how common it is among young people and about the related dangers. That's why the AMA long has supported education among medical professionals and the public regarding this form of substance abuse. Late last month, the National Inhalant Prevention Coalition marked its annual week-long effort to focus attention on this problem. The group's warning message in terms of use, abuse and dangers is certainly worth remembering. [continues 608 words]
The Action Came Within Weeks Of An FDA Panel's Ruling Against New Limits On OxyContin Prescribing Pain management physicians celebrated a victory recently when a federal advisory panel ruled against a proposal to place more restrictions on how they treat patients. But their celebration was short-lived when an outspoken member of their specialty was arrested on drug trafficking charges weeks later. With this article Links See related content The good news came Sept. 10 when a U.S. Food and Drug Administration advisory panel voted 13-5 against new restrictions on OxyContin prescribing that were suggested by the U.S. Drug Enforcement Administration and members of Congress. [continues 651 words]
Although The California Case Deals With Medical Marijuana, It Has Broader Implications For Frank Discussions Between Physicians And Patients. Physicians can discuss the pros and cons of medicinal marijuana with their patients without worry of the Drug Enforcement Administration cracking down on them, a federal appeals court ruled in October. A three-judge panel of the 9th U.S. Circuit Court of Appeals in San Francisco unanimously ruled that a 1996 federal policy that said physicians could lose their DEA numbers if they discussed the issue tramples on First Amendment rights that allow a doctor and patient to discuss medical issues. [continues 829 words]
Physicians are urged to help steer their teen and young adult patients away from destructive behavior by using incisive questions and straight answers. Washington -- Almost a quarter of sexually active teens and young adults -- about 5.6 million nationally -- have had unprotected sex because they were drinking or using drugs at the time, according to a Kaiser Family Foundation survey. "For teens, drinking and sex is at least as dangerous as drinking and driving," said Joseph A. Califano Jr., president of the National Center on Addiction and Substance Abuse at Columbia University in New York and a former U.S. secretary of health, education and welfare. The survey was released last month at a conference held at Columbia. [continues 731 words]
Rulings this term on medical marijuana, drug testing and unionization have mixed results for physicians. Justices take on the big issue -- ERISA -- this fall. The U.S. Supreme Court was fairly friendly toward the nation's physicians this year. But it could have been friendlier. In cases that took on issues ranging from whether a public hospital can perform drug tests on pregnant women without their consent and then give police the results, to whether the National Labor Relations Board had properly defined the role of a supervisor in a health care setting, the court set parameters for the practice of medicine. The pattern is: There is no pattern But it's hard to draw conclusions -- or make predictions -- based on this set of decisions on wide-reaching cases from a court that has a reputation for being hard to handicap. "The only pattern you find with the Supreme Court these days is that it will do whatever it wants," said Jay Gold, MD, editor in chief of Legal Medicine Perspectives, published by the American College of Legal Medicine. "Because of the way the court membership is fractured, it's hard to get five people," added Mary Anne Bobinski, director of the Health Law and Policy Institute at the University of Houston Law Center. "The fifth vote is hard to predict." In Ferguson v. Charleston, S.C. the swing votes came down squarely on the side of physicians. In a 6-3 decision, the court said a policy that the Medical University of South Carolina developed "in good faith" with other government agencies violated the Fourth Amendment. The policy, initiated in 1989 and discontinued five years later, led to the arrest of pregnant women and new mothers who tested positive for cocaine. The high court's decision marked the first time justices didn't give the benefit of the doubt to police in a drug enforcement case. Even though the court made the point that there was no physician-patient relationship in the Charleston case, the decision, in and of itself, is supportive of the traditional role of the physician-patient relationship. "It is protecting patients from intrusion," Bobinski said. "Medical professionals, when doing medical testing and screening, should be doing it for medical reasons," added Lawrence Gostin, professor of law and public health at Georgetown University, Washington, D.C. Court united, experts divided Legal experts are split on whether physicians and the practice of medicine can claim victory with the court's unanimous ruling on medical marijuana in United States v. Oakland Cannabis Buyers' Cooperative, et al. The decision addressed the distribution of the drug and stayed out of the medical necessity issue. [continues 857 words]
Lawsuits Against The Drug's Manufacturer Have Snowballed. And A Florida Physician Faces Murder Charges In Connection With A Prescription For The Drug. It doesn't look like the controversy surrounding the painkiller OxyContin will be abating any time soon. What started with a couple of lawsuits filed against the drug's manufacturer, Purdue Pharma, has snowballed into 13 civil cases filed in the eastern United States. And in Florida, one physician has been charged with murder, accused of improperly prescribing the drug that contributed to a 21-year-old man's death. [continues 359 words]
Rulings this term on medical marijuana, drug testing and unionization have mixed results for physicians. Justices take on the big issue -- ERISA -- this fall. The U.S. Supreme Court was fairly friendly toward the nation's physicians this year. But it could have been friendlier. In cases that took on issues ranging from whether a public hospital can perform drug tests on pregnant women without their consent and then give police the results, to whether the National Labor Relations Board had properly defined the role of a supervisor in a health care setting, the court set parameters for the practice of medicine. [continues 1195 words]
Physicians Are Urged To Offer Guidance, Information About The Dangers Of The Illegal Drug Ecstasy Washington -- Physicians should be aware that ever-increasing numbers of their young patients are using illegal "club drugs" such as Ecstasy, a synthetic, psychoactive drug that many users consider to be relatively harmless. But the drug is far from harmless. "It's a dangerous drug," said Michael Miller, MD, secretary of the American Society of Addiction Medicine, "with both stimulant and hallucinogenic properties." Patients tend to place Ecstasy in a different category from other illicit drugs, said Stuart Gitlow, MD, medical director of Nantucket (Mass.) Behavioral Services. "When we question people about using drugs they say no, but when we ask them if they are using Ecstasy they say yes," he said. [continues 642 words]
Vermont won't pay for OxyContin prescriptions for patients who receive certain state welfare benefits. Gov. Howard Dean, MD, in July said the state made the decision based on the painkiller's link to addiction and crime. In response to reports of the misuse of OxyContin, the Food and Drug Administration in July strengthened the warning and precautions section of the drug's label. It will include a "black box warning" -- the strongest for an FDA-approved drug. The agency hopes to lessen the chance that OxyContin will be prescribed inappropriately. Purdue Pharma LP, the drug's manufacturer, said the change was made voluntarily with the FDA in an effort to reduce abuse and diversion of prescription pain medication. [end]
Physicians are urged to offer guidance, information about the dangers of the illegal drug Ecstasy. Washington -- Physicians should be aware that ever-increasing numbers of their young patients are using illegal "club drugs" such as Ecstasy, a synthetic, psychoactive drug that many users consider to be relatively harmless. But the drug is far from harmless. "It's a dangerous drug," said Michael Miller, MD, secretary of the American Society of Addiction Medicine, "with both stimulant and hallucinogenic properties." Patients tend to place Ecstasy in a different category from other illicit drugs, said Stuart Gitlow, MD, medical director of Nantucket (Mass.) Behavioral Services. "When we question people about using drugs they say no, but when we ask them if they are using Ecstasy they say yes," he said. [continues 686 words]
The legislation isn't expected to raise problems with federal authorities, but the state medical association opposes it. Despite the recent U.S. Supreme Court ruling that put the kibosh on California's cannabis buying clubs, the Nevada Legislature earlier this month voted to legalize the medical use of marijuana there. The key difference in Nevada's system that some experts say should allow the legislation to go forward without much, if any, interference from the federal government is the way the law lets patients access medical marijuana. [continues 579 words]
Some physicians applaud while others bemoan the recent ruling, but all agree: More research is needed. Washington -- There's no question that the U.S. Supreme Court's May 14 decision on certain legal questions related to the medical uses of marijuana represents a setback for the drug's proponents, who believe its use helps ease some of the distress of seriously ill people. Although the ruling didn't strike down the nine state laws that allow medically needy patients to obtain the drug without fear of state prosecution, it did set up other obstacles. [continues 1028 words]
"Does it work? We don't know, but it's a system we're trying to implement to see if we can provide better services within primary care for alcohol and drug problems," Dr. Samet said. "And for our dependent patients who get into a detox, there are a lot of medical issues. If they're not getting into medical care, but they are getting into the substance abuse system, take advantage of it." These steps are just two ways to integrate what are usually distinct systems, said Dr. Samet, associate professor of medicine and public health at Boston University School of Medicine and primary author of an investigation into the benefits of linking primary care with substance abuse services. [continues 800 words]
