War against legal drugs

War against legal drugs

By RONALD FRASER
Special to the Register The very same federal Drug Enforcement Agency that has repeatedly failed to slow the flow of illegal cocaine from abroad is now waging - with help from its state partners - an alarmingly successful war against legal prescription drugs here at home.
Problem is, the tactics used to keep these drugs off the black market have a nasty side-effect: Many terrified hometown physicians no longer give 15 million Americans struggling with chronic pain the medicines they need.

In 2002, according to Dr. Joel Hochman, director of the National Foundation for the Treatment of Pain, the DEA investigated 622 physicians and brought charges against 586. In 426 cases, medical licenses were revoked "for cause."

"If the DEA continues as at present, there won't be any doctors writing opioid prescriptions in two more years," Hochman said. (Opioids, like OxyContin, are highly effective painkillers made from either opium or synthetics with the properties of opiate narcotics.)

Some observers say that the Alabama Board of Medical Examiners' 2001 decision to revoke the medical license of Dr. Pascual Herrera Jr. of Gadsden, after three of his patients died of OxyContin overdoses, reflects a "drug war mentality" that too quickly blames doctors for the actions of their patients.

State and federal agents justify their actions as a response to DEA reports that "Alabama continues to see an increase in diverted pharmaceuticals across the state, and OxyContin is still the No. 1 abused drug." In 2000, Alabama was ranked 11th nationally for the number of OxyContin prescriptions written per capita.

It is true that some pain patients do sell their pills on the black market. Others overdose by mixing prescription medicines with other drugs and die. And perhaps some physicians knowingly take part in these illegal schemes.

But most doctors under attack, claims Hochman, are not deliberately abusing their professional responsibilities. They simply need better pain control training and office management skills.

His solution is for DEA, state regulatory agencies and state medical boards to work with - rather than against - the nation's 5,000 doctors practicing chronic opioid therapy.

"To be a competent physician," says Hochman, "every doctor in the United States needs to be adequately trained - and most are not - in the management of intractable pain. Law enforcement and physicians must work together to separate the sheep from the wolves and to identify and prosecute the small number of prescription abusers.

"Targeting the physician only drives legitimate pain patients into deeper despair, terminal hopelessness and into the black market for relief - as in the case of Rush Limbaugh."

This heavy-handed approach is a three-part recipe for disaster:
Abandoned patients.
A pain practice might have 200 to 500 patients. As doctors lose their licenses, the number of abandoned patients will go up and all pain sufferers will have a harder time finding the care they need.
Where will abandoned pain patients find relief when other doctors in town are "narcophobic"? Many will turn to illegal channels, meaning these law enforcement tactics will actually create new customers for the same black market in drugs they claim to be dismantling.

Fearful doctors.

To avoid trouble, fewer physicians are likely to start new pain care practices.
Signs already appearing in doctors' offices read "Do not ask me to refill pain medications" and "Don't ask for opioids," as doctors adopt a cover-my-rear medical ethic that ignores their patients' welfare.
Even nursing home care is being harmed. Until outside pain consultants step in, terminally ill nursing home patients may not get the pain control medicines they need.

Staff physicians will be too afraid of the "drug warriors" to do their jobs.
Government intrusion.

Despite surveys that show seven of 10 Americans want their doctors, not the government, to decide what medical treatment they will receive, aggressive state and federal law enforcement tactics are bullying the medical community to under treat Americans with severe pain.
Here is how Dr. Jane Orient, director of the Association of American Physicians and Surgeons, sums up the situation: "Throughout the U.S. physicians are being threatened, impoverished, delicensed and imprisoned for prescribing in good faith with the intention of relieving pain. Law enforcement agents are using deceitful tactics to snare doctors, and prosecutors manipulate the legal system to frighten doctors who might be willing to testify on behalf of the wrongly accused doctors."
This year, federal taxpayers, including folks living in Alabama, will give DEA about $120 million to target doctors who aggressively use legal drugs to ease pain.

I wonder if these taxpayers, especially those suffering from chronic pain themselves, think this is money well spent. Ronald Fraser, Ph.D., writes on public policy issues for the DKT Liberty Project, a Washington-based civil liberties organization. He can be reached at fraserr@erols.com.
CUTLINES: Los Angeles Times The drug OxyContin is an extremely effective painkiller that has been overprescribed and abused.

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Record Number: MERLIN_1491014