Jim
12-24-2004, 12:20 PM
http://stopthedrugwar.org/chronicle/368/conflict.shtml
The long-simmering battle between federal drug law enforcers and pain management doctors, patients, and academics over the proper use of opioid pain medications such as Oxycontin is turning white hot. Between the Drug Enforcement Administration's (DEA) sudden reversal on a years-long collaborative effort with academic pain specialists over what constitutes acceptable opioid prescribing (http://stopthedrugwar.org/chronicle/365/faq.shtml) and the recent successful Justice Department prosecution of nationally known pain treatment pioneer Dr. William Hurwitz, mainstream medical organizations and personalities that had up until now been quietly complacent have begun to go on the offensive.
With tens of millions of Americans suffering from chronic pain and federal drug enforcers hell-bent on cracking down on what they term an "epidemic" of prescription drug diversion and abuse, pain patients and doctors have been caught in the middle. The crisis in pain treatment has been building for years, as zealous state and federal prosecutors go after pain treatment doctors they accuse of being no better than drug dealers. Doctors, unsurprisingly, are proving increasingly reluctant to prescribe opioid pain relievers or even to treat pain patients with opioids for fear of spending the rest of their lives in prison, a fate that has already befallen some doctors and one that Dr. Hurwitz faces when he is sentenced in March.
Pain doctors, patients and advocates fought back on several fronts this month. This week, three major medical associations representing pain specialists harshly and publicly criticized the DEA's sudden reversal on the prescribing guidelines for opioids. Those guidelines, which took the form of a "Pain FAQ," were the result of a multi-year collaboration between the DEA and academic pain specialists. They were posted on the DEA web site in August, but jerked down again weeks later without notice to the academics and replaced shortly thereafter with revised guidelines that stiffened the DEA's attitude toward what it termed improper prescribing. The letter, signed by the presidents of the American Pain Society (APS), the American Academy of Pain Medicine (AAPM), and the American Society of Addiction Medicine (ASAM) called the new DEA policy guidelines "an unfortunate step backward" that will only lead to "an adversarial relationship between doctors and the DEA."
The DEA responded with a statement from spokesman Bill Grant, who said the agency "wishes to reassure the public that the withdrawal of the August statement does not represent any change in DEA's investigative emphasis or approach. Physicians acting in good faith and in accordance with established medical norms should remain confident that they may continue to dispense appropriate pain medications."
Drug czar John Walters also attempted to address the growing controversy. At a Tuesday press conference, Walters told reporters that "synthetic opioids are of enormous medical benefit for people," but undercut himself with pain advocates by going on to say that among the doctors prosecuted as Dr. Feelgoods "there were not even any close calls."
The pain associations weren't buying it. Citing what they called "the over-aggressive prosecutions" of pain doctors, pharmacists, and other health professionals, the association presidents said that while the DEA says it does not want to stop doctors from adequately treating chronic pain with opioids, the new guidelines "will undoubtedly have the exact opposite effect on any practitioner reading them."
The association presidents, APS president Dennis Turk, AAPM president Samuel Hassenbusch, and ASAM president Lawrence Brown, zeroed in on the DEA's assertion that merely prescribing high doses of opioid pain relievers can lead to a doctor being investigated. Such statements will have a chilling effect on the practice of pain medicine, they wrote. "Reading that the government can investigate merely on suspicion that the law is being violated will send chills down the spine of practitioners who are treating patients with [narcotic painkillers] and will certainly contribute to the undertreatment or non-treatment of moderate to severe chronic pain."
"The bottom line on this letter is that if the DEA thought changes were needed, it should have engaged in a little more discussion about it and get everyone on board," said Chuck Weber, spokesman for the American Pain Society. "There was a real change in tone between what was agreed upon and posted in August and the revised guidelines issued last month," he told DRCNet. "The main concern was the lack of dialogue."
"This letter is absolutely a positive move," said Dr. Frank Fisher, a California pain specialist who was prosecuted and ultimately exonerated over his opioid prescribing practices and who served as a defense consultant in the Hurwitz trial. "Those academics spent years working with the DEA to come up with reasonable guidelines, but then the DEA jerked them down and didn't do the courtesy of notifying them," he told DRCNet. "The DEA has an absolute obligation to work with the academic community in promulgating guidelines, but what they have done is abrogate that responsibility and their duty to regulate controlled substances in a matter that makes them available to patients who need them."
The American Academy of Physicians and Surgeons, which for years has been waging a lonely struggle within the profession to protect opioid-prescribing doctors, also welcomed the intervention by the pain association heads. "Even though we weren't fans of the FAQ," said academy spokesperson Kathryn Serkes, "at least with them you got something on paper. You want government agencies to commit to something on paper so you know where the bar is, but when the bar keeps moving at the whim of prosecutors and investigators, you've got a real problem," she told DRCNet. "Doctors and patients are literally at the mercy of prosecutors and the DEA. We've been angry about this for years -- it's about time some of the other physicians' groups got angry, too. They've been manipulated and made fools of. At this point, anger is an appropriate response." full article (http://stopthedrugwar.org/chronicle/368/conflict.shtml)
The long-simmering battle between federal drug law enforcers and pain management doctors, patients, and academics over the proper use of opioid pain medications such as Oxycontin is turning white hot. Between the Drug Enforcement Administration's (DEA) sudden reversal on a years-long collaborative effort with academic pain specialists over what constitutes acceptable opioid prescribing (http://stopthedrugwar.org/chronicle/365/faq.shtml) and the recent successful Justice Department prosecution of nationally known pain treatment pioneer Dr. William Hurwitz, mainstream medical organizations and personalities that had up until now been quietly complacent have begun to go on the offensive.
With tens of millions of Americans suffering from chronic pain and federal drug enforcers hell-bent on cracking down on what they term an "epidemic" of prescription drug diversion and abuse, pain patients and doctors have been caught in the middle. The crisis in pain treatment has been building for years, as zealous state and federal prosecutors go after pain treatment doctors they accuse of being no better than drug dealers. Doctors, unsurprisingly, are proving increasingly reluctant to prescribe opioid pain relievers or even to treat pain patients with opioids for fear of spending the rest of their lives in prison, a fate that has already befallen some doctors and one that Dr. Hurwitz faces when he is sentenced in March.
Pain doctors, patients and advocates fought back on several fronts this month. This week, three major medical associations representing pain specialists harshly and publicly criticized the DEA's sudden reversal on the prescribing guidelines for opioids. Those guidelines, which took the form of a "Pain FAQ," were the result of a multi-year collaboration between the DEA and academic pain specialists. They were posted on the DEA web site in August, but jerked down again weeks later without notice to the academics and replaced shortly thereafter with revised guidelines that stiffened the DEA's attitude toward what it termed improper prescribing. The letter, signed by the presidents of the American Pain Society (APS), the American Academy of Pain Medicine (AAPM), and the American Society of Addiction Medicine (ASAM) called the new DEA policy guidelines "an unfortunate step backward" that will only lead to "an adversarial relationship between doctors and the DEA."
The DEA responded with a statement from spokesman Bill Grant, who said the agency "wishes to reassure the public that the withdrawal of the August statement does not represent any change in DEA's investigative emphasis or approach. Physicians acting in good faith and in accordance with established medical norms should remain confident that they may continue to dispense appropriate pain medications."
Drug czar John Walters also attempted to address the growing controversy. At a Tuesday press conference, Walters told reporters that "synthetic opioids are of enormous medical benefit for people," but undercut himself with pain advocates by going on to say that among the doctors prosecuted as Dr. Feelgoods "there were not even any close calls."
The pain associations weren't buying it. Citing what they called "the over-aggressive prosecutions" of pain doctors, pharmacists, and other health professionals, the association presidents said that while the DEA says it does not want to stop doctors from adequately treating chronic pain with opioids, the new guidelines "will undoubtedly have the exact opposite effect on any practitioner reading them."
The association presidents, APS president Dennis Turk, AAPM president Samuel Hassenbusch, and ASAM president Lawrence Brown, zeroed in on the DEA's assertion that merely prescribing high doses of opioid pain relievers can lead to a doctor being investigated. Such statements will have a chilling effect on the practice of pain medicine, they wrote. "Reading that the government can investigate merely on suspicion that the law is being violated will send chills down the spine of practitioners who are treating patients with [narcotic painkillers] and will certainly contribute to the undertreatment or non-treatment of moderate to severe chronic pain."
"The bottom line on this letter is that if the DEA thought changes were needed, it should have engaged in a little more discussion about it and get everyone on board," said Chuck Weber, spokesman for the American Pain Society. "There was a real change in tone between what was agreed upon and posted in August and the revised guidelines issued last month," he told DRCNet. "The main concern was the lack of dialogue."
"This letter is absolutely a positive move," said Dr. Frank Fisher, a California pain specialist who was prosecuted and ultimately exonerated over his opioid prescribing practices and who served as a defense consultant in the Hurwitz trial. "Those academics spent years working with the DEA to come up with reasonable guidelines, but then the DEA jerked them down and didn't do the courtesy of notifying them," he told DRCNet. "The DEA has an absolute obligation to work with the academic community in promulgating guidelines, but what they have done is abrogate that responsibility and their duty to regulate controlled substances in a matter that makes them available to patients who need them."
The American Academy of Physicians and Surgeons, which for years has been waging a lonely struggle within the profession to protect opioid-prescribing doctors, also welcomed the intervention by the pain association heads. "Even though we weren't fans of the FAQ," said academy spokesperson Kathryn Serkes, "at least with them you got something on paper. You want government agencies to commit to something on paper so you know where the bar is, but when the bar keeps moving at the whim of prosecutors and investigators, you've got a real problem," she told DRCNet. "Doctors and patients are literally at the mercy of prosecutors and the DEA. We've been angry about this for years -- it's about time some of the other physicians' groups got angry, too. They've been manipulated and made fools of. At this point, anger is an appropriate response." full article (http://stopthedrugwar.org/chronicle/368/conflict.shtml)