Wednesday, December 08, 2004

Bad news for patients in pain

Bad news for patients in pain

Dec 8, 2004

For millions of Americans living with chronic pain, the federal government has decided to inflict some more.

The Drug Enforcement Administration (DEA) is reverting to a heavy-handed approach of targeting doctors who prescribe "too many" narcotic painkillers, even if they follow accepted medical practice. That spells more misery for physicians and patients.

Long-term use of painkillers at high doses is often the only way some patients can relieve the agony of cancer and other diseases and lead functional lives. Undertreatment of pain is common, notes the American Medical Association, which has documented years of DEA harassment of physicians who legitimately prescribe narcotics.

In August, DEA reached a compromise with medical experts that would allow physicians to treat pain without risking prosecution for diverting drugs to abusers. But two months later, DEA abruptly broke the deal.

Officially, DEA withdrew the guidelines because they contained "misstatements." But the pain experts who helped write the protocols believe the about-face occurred because a Virginia physician facing drug charges unsuccessfully tried to use the guidelines as evidence in his trial.

The new policy is vague, and DEA promises a clarification soon. As things stand:

Physicians cannot write multiple prescriptions with instructions that they be filled on future dates. If patients run out of pills before returning to their doctors, they're out of luck, says Russell Portenoy, a pain expert at New York's Beth Israel Medical Center who helped write the now-discarded rules.

Patients with any history of substance abuse may not be able to be prescribed narcotics, even if their pain from disease is documented.

The government "can investigate (physicians) merely on suspicion that the law is being violated, or even just because it wants assurances that it is not," DEA warns. That sends a clear message: Doctors who prescribe a high volume of painkillers to alleviate suffering, the very purpose of medicine, will face intense scrutiny.

The bottom line: Patients, particularly the estimated 25 million Americans who are at least partially disabled by chronic pain, will find it tougher to obtain relief. Physicians who fear losing their licenses or liberty will limit the prescribing of narcotics, and many pharmacies will be reluctant to dispense them.

To be sure, drug seekers do scam physicians, a tiny handful of whom are indeed drug pushers. Doctors must take care to ensure that patients don't become addicted to painkillers, as happened to radio host Rush Limbaugh. And stopping illegal diversion of drugs is important. But it shouldn't hinder patients' ability to receive the care they deserve or scare doctors away from using sound medical judgment.

Law enforcement and pain relief needn't be in conflict. DEA needs to write a more reasonable prescription.