From a doctor's viewpoint, Dr. Joel Hochman, director of the
National
Foundation for the Treatment of Pain, says Washington is
engaged "in a
fruitless and bizarre effort to curtail the abuse of drugs"
that has begun
to negatively affect "its citizens and its physicians."
Of the 4,383 pain management doctors listed on the
DoctorsForPain.com
registry, 90 are located in Alabama. That averages out to
about one
chronic-pain doctor per county, meaning the loss of a single
physician can
cut off hundreds of Alabamians from access to pain care.
To the Drug Enforcement Administration, this fragile network
of care givers
is a tempting law-enforcement target.
In the 1990s, the DEA began targeting doctors who treat
patients with high
doses of OxyContin. To the DEA, these doctors look like
potential drug
traffickers and a pipeline to the black market.
Pain doctors' approach to OxyContin is to prescribe
increasingly high doses
until a patient's pain abates or side effects set in.
Because this treatment
is still controversial among some physicians, pain
practitioners are
vulnerable at trial.
In 1993, to bankroll the DEA's war on doctors, Con gress set
up a diversion
control fund. Each year, a million doctors buy a license to
prescribe
FDA-approved drugs. In 2003, this fee was doubled. The DEA
now rakes in
about $130 million per year from these fees -- money that is
used to hire
investigators to target physicians.
The agency also gets funding each year -- $54 million in
2002 -- from an
asset forfeiture fund, including assets that once belonged
to physicians
prosecuted by the DEA. These two pots of money afford the
agency the
financial incentives and the freedom from congressional
oversight to
vigorously prosecute pain doctors.
The DEA monitors the prescription writing habits of all
doctors, and those
prescribing high doses of OxyContin raise a red flag.
Investigators go to
work: Plea bargains win testimony from former patients.
Indictments are
filed.
Trial juries hear from DEA-hired doctors who say that the
use of high levels
of OxyContin are outside the normal practice of medicine.
Doctors for the
defense give contrary testimony.
Faced with conflicting expert testimony, lay juries tend to
convict.
In the past three years, according to Hochman, the DEA
investigated about
1,800 doctors nationwide -- 1,200 of whom lost their
prescription license.
"When doctors are investigated by the DEA," Hochman said,
"their usual
response is to cease treating pain patients." Assuming each
doctor serves
300 patients, as many as 180,000 pain patients lose their
care providers
each year, according to him.
Each publicized DEA investigation and conviction spreads
fear. Other doctors
may voluntarily get out of, or decide not to go into, the
practice of pain
management.
To catch the few bad doctors, the DEA is driving many more
good ones out of
business.
Some patients who lose their support systems turn to the
black market or
even suicide for relief.
Dr. Jane Orient of the Association of American Physicians
and Surgeons,
believes that the DEA uses "dirty tricks" to convict
doctors.
"Physicians are being threatened, impoverished, de-licensed
and imprisoned
for prescribing in good faith with the intention of
relieving pain," Orient
said. "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."
In March 2004, DEA administrator Karen Tandy told Congress
that her drug
warriors have "been successful in addressing OxyContin
diversion, as
evidenced by a reduction in the rate of increase of
OxyContin prescriptions
being written and a leveling-off of OxyContin sales."
But this cockeyed measure of success makes no sense.
Respected experts
estimate the pain experienced by 40 percent of cancer, AIDS
and terminally
ill patients already goes under-treated.
Thanks to DEA, Orient predicts, "If you have an operation or
an acute
injury, chances are your doctor will order adequate pain
medication. But if
you are one of the millions with chronic, intractable,
so-called 'benign
pain,' you may be told to learn to live with it."
Bottom line? The loss of one Alabama pain physician will not
create a ripple
in the black market. But 300 honest citizens in pain may
curse the DEA's
tactics when they are told, "Learn to live with it."