Pain Relief Network

Dec 8, 2006
By: Russell K. Portenoy MD
Painreliefnetwork.org

RE: Mr. Richard Paey

Dear Governor Bush:

I was informed that you will be asked to consider a request for clemency in the case of Mr. Richard Paey, a chronic pain patient who is currently in prison on drug charges. I am writing to express my support of this action. I have been involved in pain management for many years and learned about this case when I was asked to comment on its medical aspects for “60 Minutes.” I do not know Mr. Paey personally but the information available indicates that any questionable actions he took, actions which led ultimately to his arrest, were driven by desperation related to uncontrolled pain. In the absence of any evidence of drug trafficking, or drug abuse or addiction, the handling of his case by the criminal justice system has been viewed as unjustified and extreme by the national community of pain specialists. This type of response frightens physicians and patients alike, increases the stigma associated with the use of controlled prescription drugs for pain, and may increase the reluctance of professionals to treat pain aggressively.

Mr. Paey experienced intense chronic pain for many years, which was inadequately treated by physicians in the past. The dose of systemic opioid medication he required to relieve his pain was relatively high, but clearly in the range used by pain specialists in this country. The number of pills or milligrams of an opioid required for analgesia says nothing about any of the negative outcomes associated with these drugs–including abuse, addiction and diversion–and reference to the amount of drug as evidence of these outcomes by regulators or law enforcement should not be condoned. Mr. Paey’s case has been interpreted as another in which information about dose was misused by prosecutors, resulting in conviction in the absence of evidence of criminal intent.

Evidently, the courts will be unable to reverse a miscarriage of justice in this case. The negative impact extends beyond Mr. Paey and his family to a national movement devoted to improved access to appropriate pain care. Clemency is warranted to redress the wrong that has occurred and send a message to both clinicians and patients that the government supports the legitimate need to use controlled prescription drugs to treat chronic pain. Although mistakes are made, your action in this case will show that corrections that are appropriate and just can be successfully pursued.

Sincerely,

Russell K. Portenoy MD
Chairman and
Gerald J. and Dorothy R Friedman
Chair in Pain Medicine and Palliative Care
Department of Pain Medicine and Palliative Care
Beth Israel Medical Center

Professor of Neurology and Anesthesiology
Albert Einstein College of Medicine

Chief Medical Officer
Continuum Hospice Care