- Twenty-four years after Darlene broke her back in a swimming
pool accident, crippling pain still rules every aspect of her life, from
getting up in the morning (which she describes as akin to "climbing
the highest mountain") to falling into a fitful sleep at night. After
years of botched surgery that left her in even more agony, she knows there
is no real cure for what ails her, but thanks to synthetic opioids (which
include such regulated substances as Vicodin, Dilaudid, and the devil drug
of the moment, OxyContin), she says that she can now lead a halfway normal
life. Just folding sheets or washing dishes or sitting at the computer
are daily miracles for Darlene, who claims she would otherwise be bedridden
and suicidal without the chemical crutches that high doses of these powerful
opium-like painkillers provide.
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- But in some ways worse than the pain, says Darlene (who
doesn't want her last name revealed), are the shame and fear that come
with it. Shame when she goes to have her special triplicate prescriptionórequired
for all scheduled drugsófilled at the drugstore and the pharmacist
looks at her as if she were some addict abusing the drug to get high. Fear
that her medications will soon be taken away by the Drug Enforcement Administration's
ongoing crackdown on pain doctors. "You worry every day that the medicine
won't be available for much longer, or your doctor won't be there tomorrow
because he's been arrested by the DEA," she claims. All the bad publicity
in the press about the abuse of OxyContin by celebrities such as Rush Limbaugh
and Courtney Love doesn't help matters. But, says Darlene, the media scare
stories shouldn't blind people to the fact that these drugsówhen
taken under medical supervisionóhave made life livable for hundreds
of thousands of chronic pain patients, herself included.
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- Some in the medical community call it "a war on
pain doctors," others "a government jihad" or "state-sponsored
terrorism." However you describe the current campaign, which according
to pain-patient advocates began under Janet Reno, but which they say has
increased in intensity under John Ashcroft, the DEA's hardball tacticsóstorming
clinics in SWAT-style gear, ransacking offices, and hauling off doctors
in handcuffsóhave scared physicians nationwide to the extent that
legitimate pain sufferers now find it increasingly difficult to get the
medicine they need. Doctors' offices today display signs that say "Don't
ask for OxyContin" or "No OxyContin prescribed here." And
medical schools advise students not to choose pain management as a career
because the field is too fraught with potential legal dangers.
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- "The war on drugs has turned into a war on doctors
and pain patients," says Dr. Ronald Myers, president of the American
Pain Institute and a Baptist minister who operates a string of clinics
for poor people in the Mississippi Delta. "Such is the climate of
fear across the medical community that for every doctor who has his license
yanked by the DEA, there are a hundred doctors scared to prescribe proper
pain medication for fear of going to prison. The DEA is creating a situation
where legitimate pain patients now have to go to the streets to get their
medication. It's a health care catastrophe in the making." (Myers
theorizes that Rush Limbaugh is probably "a neglected pain patient"
and another victim of the crackdown: "Why else would someone with
all his money have to go to the street to get enough medication, other
than if he couldn't find a doctor to give him an adequate supply?")
-
- Advocates for pain doctors and their patients have had
enough. Limbaugh's recent admission that he's addicted to OxyContin and
other painkillers has brought the issue of pain management and the law
to the fore in the media. But the September arrest of northern Virginia's
Dr. William Hurwitzóa respected if controversial pioneer in high-dosage
pain treatmentógalvanized opposition among physicians and patients
to the DEA's harsh approach. Hurwitz, a leading specialist in his field,
was arrested on federal drug-trafficking charges, accused of prescribing
excessive quantities of OxyContin to addicts who he knew were selling the
drugs on the street. The 49-count indictment alleges that his prescribing
practices led to the death of three patients and bodily harm to two others.
Federal prosecutors have depicted Hurwitz, a contentious figure who has
had his license suspended three times by medical boards, as no better than
"a street-corner crack dealer . . . who dispensed misery and death."
After initially being threatened with the death penalty, Hurwitz now faces
life in prison.
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- But others defend the doctor. "Dr. Hurwitz saved
my husband's life," says Siobhan Reynolds, founder of the Pain Relief
Network, a New York City-based grassroots organization defending pain doctors
and their patients. For over a decade, Reynolds's husband has suffered
terrible head pain caused by a connective-tissue disorder. "Other
doctors treated my husband like a leper. If it weren't for Dr. Hurwitz,
he would have killed himself. Dr. Hurwitz is responsible for every day
that my son has a father."
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- After the arrest, the Association of American Physicians
and Surgeons condemned the prosecution at a news conference held at the
National Press Club in Washington, D.C., saying that doctors who treat
pain patients are heroes, not felons. A major protest on the National Mall
is being organized by the National Pain Patients Coalition for next April
to bring attention to what some experts regard as the No. 1 health issue
in America: the under-treatment of chronic pain. And a push is on in various
states to get politicians to pass bills guaranteeing patients' right to
opioids to alleviate their suffering, if a doctor deems it necessary.
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- Siobhan Reynolds: "All over America, pain patients
are committing suicide because of the DEA's campaign." (photo: Brian
Kennedy) Many doctors used to think that extreme pain was something that
their patients just had to live with. The pain-management movement that
has sprung up over the past few years takes a radically different tack,
believing that long-term chronic pain can be managed with large amounts
of synthetic opium, a treatment that remains controversial both within
and outside the medical community. The extremely high doses often prescribedósometimes
dozens of pills a dayócan seem dangerous and excessive to both laymen
and other physicians. A number of doctors insist that these drugs are so
powerful that no one should be prescribed them except end-stage cancer
patients. But pain-management advocates argue that despite the scare stories,
drugs such as OxyContin are actually safer than the alternatives and are
much more effective.
-
- The DEA denies there's been an increase in investigations
and prosecutions of physicians and refutes the notion that it's engaged
in a crackdown on pain doctors in general. The agency insists that it's
after only rogue practitioners who overprescribe the medicines and who
knowóor should knowóthat their patients are selling the drugs
on the black market. So far this year, says the DEA, the agency has launched
557 investigations, pursued actions against 441 doctors, and arrested 34,
a small fraction of the nearly 1 million physicians licensed to dispense
controlled drugs. "DEA statistics," the agency proclaimed on
October 30, "show that the vast majority of practitioners registered
with the DEA comply with the requirements of the Controlled Substances
Act and prescribe controlled substances in a responsible manner."
The agency added, "Doctors operating within the bounds of accepted
medical practice have nothing to fear from the DEA."
-
- But some doctors believe that the DEA, having conspicuously
failed to stem the tide of illegal drug use in this country, is coming
after physicians to ratchet up the agency's prosecution count. (This year
alone, two federal reviews lambasted the DEA for its poor performance in
fighting illegal drug use, one report giving the agency a zero on a scale
of one to 100.)
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- "They're unable to take down the real drug lords,
so they're coming after doctors using the same tactics," one pain
physician tells the Voice. For an agency keen to justify its massive budget,
doctors provide an easy target. Consider some other recent cases:
-
- In Roanoke, Virginia, pain specialist Dr. Cecil Knox
and two of his associates were accused of operating what federal prosecutors
call "a pill mill." Prosecutors alleged that Knox overprescribed
OxyContin and methadone to increase the profits of his financially struggling
operation and that this contributed to the deaths of eight patients. Armed
agents in flak jackets raided Knox's office. "They all came in with
guns drawn," a clinic employee who was present during the raid reported
to the Pain Relief Network. "I thought I was going to die. My husband
was helping out that day, and a DEA agent came in and pointed a gun at
his head and said, 'Get off the phone now.' " (As this story went
to press, news came that the feds failed to win a single conviction in
the case; the jury cleared Knox of 30 of the 69 charges, deadlocking on
the remaining counts.) In another case of DEA strong-arm tactics, more
than 20 agents burst into a Dallas pain clinic in June. The agents kicked
down doors, ransacked the office of Dr. Daniel Maynard, and handcuffed
patients, including an elderly woman with a stroller and an oxygen tank.
-
- In South Carolina, physician Deborah Bordeaux was convicted
earlier this year under a federal drug-kingpin statute and is currently
awaiting sentencing. She faces up to 100 years in prison as a major drug
dealer for dispensing opiates to patients suffering from chronic pain at
a Myrtle Beach clinic, where she had worked for only two months. Dr. Benjamin
Moore, who worked at the same clinic, committed suicide in July 2002 rather
than testify against his co-workers.
-
- In Arkansas, Dr. Randeep Mann claims that a patient approached
him in 2002 and told him that a federal agent had offered her $250 to say
that Mann had prescribed her painkillers in exchange for sex. Mann also
charges that another female patient told him that local authorities had
offered to forgive her cocaine arrest if she told the same lie in court.
"They destroyed my practice and they've managed to run away a lot
of my patients, and I can no longer prescribe opioids, but I still have
my license," Mann tells the Voice.
-
- In New Orleans, Dr. David Jarrott, who specializes in
pain management, claims that an undercover DEA agent posing as a truck
driver tried to entrap him by giving him fake X-rays to secure a supply
of Vicodin for a supposed bad back. Jarrott also says the same agent tried
to bribe him for amphetamine-based diet pills claiming he needed to stay
awake while driving his truck. In early October, the doctor had his license
suspended for three years after two of his patients died, one of whom,
unbeknownst to Jarrott, was mixing street drugs with his legitimate medication.
-
- In Arizona, Dr. Jeri Hassman, who runs Tucson's biggest
pain practice, was indicted in March after a sting involving two undercover
agents and a three-time-convicted felon. She is being threatened with a
28-year prison term because some of her patients abused prescriptions she
wrote.
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- It's not just on the federal level that harsh punishment
is being meted out. Dr. Robert Weitzel from Utah was convicted of negligent
homicide and sentenced to 15 years in prison. He gave morphine to a 91-year-old
patient, who soon after died of heart disease. Weitzel won a retrial (and
acquittal) in November 2002 after it was learned that a local prosecutor
had concealed exculpatory evidence. In Florida in the same year, Dr. James
Graves was not so lucky, becoming the first U.S. physician to be convicted
of manslaughter related to an OxyContin prescription, after local authorities
charged that four of his patients fatally overdosed on OxyContin, some
of them after combining it with illegal street drugs. Graves contended
that his patients would not have died if they had taken the drugs as directed.
He is currently serving 63 years.
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-
-
- Federal officials claim that nearly 500 people died from
overdosing on OxyContin in 2002, but a recent article in The Journal of
Analytical Toxicology could find only 12 cases in which OxyContin was the
sole cause of death; all the others fell victim to poly-drug abuseómixing
OxyContin with cocaine, alcohol, Valium, or various other substances.
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- "Opioids when taken under clinical supervision are
not that dangerous," says the American Pain Institute's Myers. "The
data tells us that only 3 percent of people who take opioids become addicts.
The latest research conclusively shows that the best medicines for the
treatment of chronic pain are narcotics. They have less side effects and
more benefits than any other type of drug."
-
- More dangerous, contends Myers, are the everyday drugs
that pain sufferers turn to when they can't get narcotics. He talks about
something called "suicide by Tylenol": "When chronic pain
patients can't get opioids, they go out and use tremendous amounts of drugs
like Tylenol and Motrin, which can cause serious liver and kidney damage.
Pain patients are dying from kidney and liver disease because of this."
-
- Many pain patients are also dying by their own hand,
according to the Pain Relief Network's Reynolds. "All over America,
pain patients are committing suicide because of the DEA's campaign,"
she claims. "I know of at least 17 recent cases in Arkansas alone.
It's really astonishing the amount of human carnage that this campaign
has already caused."
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- Fumes Myers: "What's going on here is morally reprehensible
and medically incomprehensible and it has to stop. Doctors who treat pain
patients are not criminals."
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- http://www.villagevoice.com/issues/0345/owen.php
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