Doctors: The new target in the war on drugs? - Some critics think so, and they're blaming the DEA and other agencies for trying to make up for past failures. - Medical Economics | Practice Management
At a time when medical science offers doctors a potent arsenal of opioid and other drugs to treat pain, many patients still
can't get the relief they need.
Power Points
The numbers are stunning. More than 50 million Americans experience chronic pain, according to data cited by the American
Pain Foundation. Nearly 25 million others have bouts each year of acute pain, typically as the result of an injury or surgery.
Of those who need relief, as few as one in four receive the proper treatment.
Why are people suffering, despite remedies at hand to help them? Certainly, pain specialists are in short supply—there are
fewer than 6,000, by one estimate—and so are the primary care nonspecialists who have enough knowledge and training to pick up the slack. But it's doctors' fear of being targeted as criminals
that creates the biggest barrier to proper pain treatment, many experts say.
Doctors weren't always afraid of being led away in handcuffs. In the past, those who treated pain aggressively were more afraid
that their medical board, especially in certain parts of the country, would come in and restrict their privileges or yank
their licenses altogether. (See, "Pain Control: Did Dr. Lewis cross the line?" March 7, 2003). These days, however, many in and outside of the profession give medical boards higher grades. "Pain management
has been a focus for us for the past several years, and we're very pleased at how our members have responded," says Dale L.
Austin of the Federation of State Medical Boards.
But as the media and others have talked up the problem of Rx diversion, doctors have come under increasing surveillance by
the Drug Enforcement Administration and its counterparts in the states. True, diversion is a problem in some areas, say critics,
but they fault the DEA and state agencies for the way they're addressing the problem, accusing these agencies of sometimes
doing an end run around medical boards.
"The DEA and state agencies have been treating doctors as if they're drug dealers," says Ronald T. Libby, a professor of political
science and public administration at the University of North Florida. "Doctors have become part of the war on drugs."
Such charges, says the DEA, are wildly overblown. Drugs are diverted primarily through pharmacy robberies, prescription forgeries,
and fraudulent Internet sales, says Rogene Waite, a DEA spokesperson, in a written statement. "Doctors who prescribe controlled
substances in their legitimate medical practice have nothing to fear from DEA." (The agency declined a Medical Economics request for an interview.)
But it's the phrase "in their legitimate medical practice" that worries many people. Under the Controlled Substances Act (Title
II of the Comprehensive Drug Abuse Prevention and Control Act, passed in 1970), the DEA registers physicians and other professionals
to prescribe controlled substances as long as they do so in the "usual course of their professional practice." Over time,
say critics, the DEA has taken this to mean that it can decide when doctors treating pain are practicing legitimate medicine.
That interpretation, these same critics say, is a bold example of the federal government overstepping its authority and treading
in areas traditionally reserved for state medical boards. This January's Supreme Court ruling in Gonzalez v. Oregon appears
to support that view, at least when it comes to physician-assisted suicide. Advocates of better pain treatment hope the physician-assisted
suicide ruling—which said the Feds can't threaten doctors who prescribe controlled substances to induce death—will boost their
cause, as well. (See, "Special Report: Assisted suicide survives—narrowly," Feb. 17, 2006).
Meanwhile, many say, the government's mission has resulted in more physician investigations and high-profile prosecutions,
which, in turn, have sent a bigger chill through the prescribing community and exacerbated the epidemic of undertreated pain.
The "War on Drugs" has failed. A new approach is required.
Criminalization has resulted in corruption of government officials
because of the vast profits to be made in the drug trade. Drug
users must engage in petty crimes to obtain money to sustain their
habits. Huge sums of capital are exported out of the US and
diverted from use in the US.
Debbie Heck, MD / Muncie, IN, UNITED STATES
Posted May 19 2006 05:09PM
Excellent article. I practice a lot of pain management, in part
because few doctors in my community will. It hurts me to see people
who greatly desire to work be unable to do so because they are in
pain but can't find a doctor to listen to them and believe their
pain is real. Even before many patients can tell their legitimate
stories regarding how they sustained their pain-in-the-back injury,
the doctor has decided the patient is a "drug seeker" and is
writing a note not to treat the patient with anything stronger than
ibuprofen. The patient picks up on this vibe and feels demeaned and
embarrassed. I am working on a project with the help of people with
chronic pain. They are recalling their experience with chronic
pain--how they felt upon diagnosis, how they were treated medically
and psychologically comparing that with how they WISH they had been
treated, how their lives changed when they were finally placed on a
successful treatment plan (if they have reached that stage yet), or
anything else they would like doctors to know when they have a
patient in pain sitting in front of him/her. So far, patients want
to be heard, respected, listened to, and believed rather than
treated like a number and rushed. I have tried very hard to follow
those tenets of practice and hope I will never waver from it. In
return, I require honest from my patients. If patients are at all
dishonest with me, I have trouble trusting them. And if I have to
practice in an environment feeling the DEA is constantly at my
door, ready to haul me away at any time I can't feel free to do my
best for each patient. As long as I know I have documented why I am
prescribing medications for each patient, I trust I have nothing to
worry about.
Family Physician /
Posted May 29 2006 01:40PM
GREAT ARTICLE. This is a great article and so true. The intrinsic
problem, I think, is that often there is no way for any doctor to
know whether the patient who complains of chronic pain really
suffers from chronic pain or is faking it to get drugs that he is
abusing or selling on the street. Pain is a subjective sensation
and there is no objective test to measure it. Occasionally, we know
the patient must feel pain, such as post-operatively, post-injury,
cancer, or when there is an obvious fracture on the X-ray. But
often the patient complaining of pain has none of these. Therein
lies the dilemma: should we give the patient the benefit of the
doubt, and prescribe, or the give the DEA/boards the benefit of the
doubt and refuse narcotics? Given two bell curves, and a line to
distinguish them, there will be some false positives and false
negatives with any test. And that is the root of the problem.
Frank B. Fisher / El Cerrito, CA, UNITED STATES
Posted Jun 04 2006 02:16AM
Mr. Gublielmo?s terrifying article accurately addresses the
chilling effect on the prescribing of opioid analgesics that
results from the threat of unwarranted prosecution that well
intentioned pain treating physicians currently face. The result is
an entirely preventable public health disaster, in which the
sickest and most vulnerable members of out society are approached
by their physicians with an attitude of suspicion, and
systematically abused. This suspicion of patients is an abrogation
of the most fundamental principle guiding the practice of ethical
medicine; the physician?s obligation to put the interests of his
patient foremost. Instead, physicians are currently required to put
the governments aims, and their own survival ahead of the interests
of their patients. Historical precedent reminds us that when the
government seizes control of the physician/patient relationship,
atrocities inevitably follow. On this basis, the universal
undertreatment of chronic pain is best understood as the result of
collapse of medical ethics. Frank B. Fisher, M.D.
frankbfisher@sbcglobal.net
Siobhan Reynolds / New York, NY, UNITED STATES
Posted Jun 04 2006 10:31AM
Great to see such a stong article. Pain Relief Network was formed
to address the legal errors driving these cases against doctors and
to confront the government in this dangerously misguided campaign.
While it is true that excellent documentation and a perfectly clean
practice may be helpful once a doctor is targeted, the truth is
that most doctors are understanably unwilling to risk prosecution
at all and do not treat pain, as a result. This leaves patients
(who are sometimes also doctors) in a terrible situation, unable to
find care and unable to recover from conditions that are perfectly
survivable with pain treatment. What has developed is a fundamental
denial of our right to life, and liberty without due process of
law. We at Pain Relief Network are the only organization that is
standing up for the doctors who treat pain. Ultimately, we are
going to have to get the federal police out of medicine. Please
come to Pain Relief Network and support our efforts to end the
madness. Siobhan Reynolds Pain Relief Network
Tim Smallwood / Seymour, IN, UNITED STATES
Posted Jun 08 2006 04:36PM
As a patient with FMS and other problems including back and neck problems, I can't even move without pain meds. I've lost everything because I can't find a doctor to treat me. I currently go to a pain center, and I have passed every test given to me including pill counts, urine tests, etc, and yet I can't get them to believe that I'm in the pain that I am.. It's amazing at the amount of docs that I went to trying to get relief. Most of the time I was given doses of drugs such as Elavil, or SSRI's, Nuronton, etc, which are not meant for pain, and usually made me even more ill and more fatigued! I finally found a pain doc that helped, but he would only help so far, explaining that if he prescribed too much he would be under DEA suspecion and that they were investigating him.. So, I only get half treated. It's like being half well all the time. Doctors are being targeted because it's like shooting ducks in a barrel, or actually, it's easier! Thank you so much for writing this article, and god bless PRN and all those that help! Tim Smallwood Seymour, In..
D.J. Black / Red Bluff, CA, UNITED STATES
Posted Mar 23 2007 03:36AM
Thank you for a wonderful article, it was well written and to the point! This country is in the middle of a public healthcare disaster the likes of which have not been seen since Prohibition! It's a disgrace: Treating doctors like they are street level drug dealers; and all because the DEA and the DOJ are impotent, powerless to stop the influx of narcotics onto the streets! When will the government realize that they are the reason that drugs are so rampant today? By making opiates a controlled substance, much the same as with alcohol during Prohibition, they paved the way for a lot of money to be made. So much so that they will NEVER win the War On Drugs. For every dealer, supplier, Cartel, etc., they take down, ten want to take their place! But for every doctor they take down, NONE want to take their place: In fact, it makes the other pain management doctors quit treating pain altogether, leaving more tragedy in their wake. All for the sake of a conviction, another "notch on their gun". Please let doctors be doctors, and you cops be cops! Thank You.
DR PAUL BONETZKT / RUSSELLS POINT, OH, UNITED STATES
Posted Jul 31 2007 05:40PM
THE MAJORITY OF MY PATIENTS IN PAIN ARE BEST TREATED WITH OPIATES FOR PAIN. WHERE IS THE DEA WHEN IT COMES TO 10,000 PATIENTS DYING YEARLY FROM NSAIDS? WHERE ARE THEIR COMMENTS REGARDING 170,000 PATIENTS GETING ADMITTED TO THE HOSPITAL FOR GI BLEEDS, ETC YEARLY. IT IS MORE THAT I BELIEVE THE DRUG COMPANIES WOULD RATHER YOU PRESCRIBE $300 WORTH OF CELEBREX THAN $30 OPIATE,
Practice Tools
Posted May 19 2006 03:42PM
