Pain Relief Network

Dec 31, 2004
By: Siobhan Reynolds
Painreliefnetwork.org

Dear Drs. Brown, Hassenbusch, and Turk,

The field of pain medicine finds itself at a critical juncture in its relationship with Federal law enforcement. We are heartened to learn that your organizations are now condemning the DEA’s recent disavowal of the FAQs document. At the same time, we are troubled by the fact that academic leadership continues to maintain certain crucial premises that perpetuate the damage being done to pain victims and their families through the government’s ongoing persecution of pain-treating physicians.

One of these premises becomes apparent when your letter states that “At times patients were allowed to suffer because physicians had unrealistic fears of sanctions for legitimate prescribing.” This statement is misleading. Physicians do not “at times allow” patients to suffer. Allowing patients to suffer is in fact the manner in which the vast majority of physicians, and the medical profession as a whole, deals with those in chronic pain.

Available evidence delineates the lack of available care that patients face. At a recent congressional briefing, Dr. Ronald Libby stated that “only 16 doctors in Florida prescribed more than $1 million in opiates during 2003, and out of 56,926 physicians, only 574 prescribed as much as $100,000 worth. (Sun-Sentinel,
“Deaths Mount as Doctors, Pharmacists and patients abuse the Medicaid System,
November 30, 2003.) Note: The vast majority of these deaths were inaccurately attributed to opioid overdose.

The above data reveals that only one percent of the physicians in Florida are responsible for prescribing substantial amounts of opioid analgesics. Assuming that the Florida numbers are representative of the country as a whole, only one percent of the 963,385 total physicians, or less than 10,000 are responsible for treating the estimated 30 to 80 million patients who suffer from chronic pain in our country. Additionally, this data suggests that the risk of criminal prosecution posed to pain-treating physicians is two orders of magnitude higher than that recently stated by the DEA, in a belated attempt to reassure members of the medical profession.

Given these circumstances, it is untenable for your organizations to continue to assert that physicians’ fears of regulatory intrusion are unrealistic. The maintaining of such a posture serves only to isolate your most loyal colleagues, those who follow the science and believe reassurances that they will not be persecuted for their good faith treatment of patients suffering from chronic pain.

At PRN, we have encountered a great deal of resistance when it comes to awakening the public and the Congress to the reality that pain is vastly under treated. This is largely due to the fact that your organizations have failed to tell the public and your memberships the truth. This was perhaps understandable when it was generally believed that the pain crisis could be resolved through cooperation with law enforcement. In light of recent developments around the FAQs document, the DEA’s ongoing denial of the existence of a pain treatment crisis, and the fact that this crisis results from the regulation of medical practice by law enforcement, your organizations’ assent is no longer acceptable.

While pain leadership and the DEA were “working together to ensure patient access to opioids,” the DEA continued its rampage prosecuting innocent physicians. The amount of damage done to our communities, both to pain treating physicians and to the patients who were served by them cannot be overstated. To continue to ignore what has been happening over these last several years is to compound the harm.

The issue of good faith is central to the ongoing debate. On December 7th 2004, while the witch trial of Dr. William E. Hurwitz was proceeding, DEA
Administrator Karen Tandy reassured American physicians in a USA Today editorial that those physicians who prescribe in good faith are safe from prosecution. However before the ink was even dry on that editorial, the
Assistant United States Attorneys prosecuting Dr. Hurwitz, were in the courtroom demanding that Judge Wexler not instruct the jury that good faith is a defense against the drug distribution charges he faced. In the absence of a good faith jury instruction, Dr. Hurwitz was effectively convicted criminally of medical negligence.

At this juncture, one might note that while a gram of oxycodone, the active ingredient in Oxycontin, was calculated as the equivalent of 500 grams of marijuana for sentencing purposes in 2001. Under current Federal Sentencing
Guidelines the multiplier has changed to 6700 grams. The result is that a physician will now draw a life sentence if convicted for having improperly prescribed as little as one bottle of Oxycontin. Given this knowledge, only a fool or a saint would prescribe opioid analgesics to patients in chronic pain, and the vast majority of physicians, as you know, are neither.

Cooperation with law enforcement can never produce a resolution to the pain crisis, because the regulation of pain management by law enforcement precludes evidence-based standards from taking hold in the medical community. This is because law enforcement pursues a drug war agenda, rather than one that is based on science and humanitarianism. Current standards require the medical profession to function in a quasi law enforcement role as the administrator of a system of drug control. Within this paradigm, the availability of pain control will continue to remain a myth that receives only lip service.

Under the present law enforcement based standard for pain management, patients’ lives are being destroyed. As physicians, your medical practices are under constant threat and the ethical practice of medicine is foolhardy. It is time for your organizations to tell the truth, and to bring this monstrous charade to an end.

As the voice of suffering patients, we at PRN request that you disavow your organizations’ head-in-the-sand attitude towards the ongoing and worsening public health disaster that is the undertreatment of chronic pain. We call upon you to work with us to bring about a US Commission on Pain, which will air these disturbing truths, and bring about the necessary changes in social policy that will make available treatment of chronic pain a reality.

At the upcoming hearings, please call for the end of the regulation of medical practice by federal law enforcement. By standing with us in support of a system that regulates controlled substances rationally, you will legitimize the field of pain management, as well as rescue it from impending extinction.

Very Truly Yours,

Siobhan Reynolds
President
Pain Relief Network