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Prosecuting Pain Doctors

Montana Case Gets International Attention

Physicians are under intense scrutiny because of concerns over prescription drug diversion and abuse. At the same time, they are also under pressure from patients and advocates to prescribe adequate pain medication.

A case in Montana recently gained international attention. Time Magazine-Canada reported on July 25, 2005 ( "Why Is The DEA Hounding This Doctor?") that "On a cold morning last April, in the shadow of Montana's Beartooth Mountain range, five agents from the U.S. Drug Enforcement Administration ( DEA ) walked into the office of Dr. Richard Nelson, a Billings neurologist. For six hours, they combed through his records, seizing 72 patient charts and confiscating his drug-dispensing permit. The charge? None so far, but the assumption is that he is suspected of improperly prescribing narcotic drugs. Despite a distinguished professional record spanning more than four decades, Nelson has had to spend $20,000 on lawyers, fearing that the government will indict him if it turns out that one of his patients has misused his medicine. 'My practice is sunk,' says the physician, 73, who specializes in chronic-pain treatment. 'I can't even write a prescription for Tylenol 3 if someone has a migraine.' The DEA, for its part, says it was acting on tips from 'several individuals in the community and pharmacies ... regarding suspicious prescriptions,' according to a spokesman, who declined to elaborate."

Fewer than 10% of investigations of medical doctors result in prosecutions, according to Time: "No one is denying that federal and state officials, under pressure to combat a spike in pain-killer abuse, are waging an escalating war on drugs that is spilling into the waiting rooms of neighborhood doctors in the U.S. Over the past six years, more than 5,600 physicians from Alaska to West Virginia have been investigated on suspicion of 'drug diversion.' Some doctors allegedly prescribed narcotics too freely, while others issued them to patients who turned out to be dealers or addicts. More than 450 doctors have been prosecuted on charges ranging from illegal prescribing and drug trafficking to manslaughter and murder. But in the U.S. government's new crackdown, legitimate physicians and patients may be getting caught in the net. 'Fifty million Americans are in severe pain from arthritis, back injuries, cancer and other disabilities,' says Dr. Scott Fishman, president of the American Academy of Pain Medicine. 'But the government is sending a message to avoid prescribing strong pain-killers.'"

Time noted that "Ultimately, it may be the patients who get hurt most, because a growing number of doctors, frightened of government scrutiny, are avoiding the use of powerful narcotics such as OxyContin, Vicodin, Percocet and Dilaudid. 'It is impossible to be sure that a patient is not diverting any of his medication,' says Dr. Thomas Stinson, a Medford, Massachusetts, anesthesiologist who is closing his 20-year practice to new pain patients. 'I fear I might be targeted.' In the past year, hundreds of sufferers have contacted the Baltimore-based American Pain Foundation. 'They've gone to every physician within hundreds of miles and can't get someone to prescribe to them,' says executive director Will Rowe. In some cases, patients with high-dosage prescriptions are turned away by drug stores, which are also subject to DEA investigations. 'It's demeaning,' says Mary Vargas, a Maryland attorney whose spine was injured in an auto accident. 'Pharmacists tell me they don't have the medication, only to recant and dispense it when I persist with the manager.'"

Opposition to such over-reactions has been growing. Time reported that "When OxyContin, a time-release version of the opioid oxycodone, was introduced in 1995, drug addicts learned to grind up the pills to get a quick, intense high; in pockets of Appalachia, Maine and Ohio, OxyContin became the drug of choice. Meanwhile, celebrity abusers--including radio talk-show host Rush Limbaugh and singer Courtney Love--sparked a flurry of publicity, leading politicians to push for a crackdown on what was being called an epidemic of prescription-drug abuse. But the dimensions of that epidemic are in dispute--and from unexpected quarters. Last week a spokesman from the White House Office of National Drug Control Policy warned Time that while prescription-drug abuse is a serious problem, and growing among teens, the numbers in a highly publicized study from Columbia University's National Center on Addiction and Substance Abuse are 'not a reliable estimate.' The survey describes a near doubling of prescription-drug abuse from 1992 to 2003, but because of changes in the way federal statistics were gathered in the past decade, no such claim can be made, the spokesman said. Last month the libertarian Cato Institute issued a report, Treating Doctors as Drug Dealers: The DEA's War on Prescription Painkillers, charging that the agency exaggerated reports of OxyContin deaths and overdoses. Nonsteroidal anti-inflammatory drugs ( nsaids ) like aspirin and ibuprofen, which can lead to intestinal bleeding, cause 35 times more deaths a year than OxyContin, the Cato report contended, and are far less effective. The DEA's $154 million drug-diversion campaign is also under attack by state officials. In a stinging 10-page critique issued last March, 32 state attorneys general, led by Oklahoma's Drew Edmondson, charged that the agency's proposed criteria for investigations would force severely ill patients to make frequent, unnecessary doctor visits, thus increasing both their hardship and their co-payments. 'DEA is creating a climate that .. discourages good practice,' they wrote."

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