#296 D.E.A. Dictates Doctor Confusion

Date: Mon, 25 Oct 2004
Subject: #296 D.E.A. Dictates Doctor Confusion


*********************PLEASE COPY AND DISTRIBUTE*************************

DrugSense FOCUS Alert #296 Monday, 25 Oct 2004

This past week, the Drug Enforcement Administration removed from its
website a document titled ‘PRESCRIPTION PAIN MEDICATIONS: Frequently
Asked Questions and Answers for Health Care Professionals and Law
Enforcement Personnel.’ saying it contained misstatements. See

While most websites have removed the document, a web search today
still finds copies, like the one at http://headaches.about.com/library/meds/pain_meds_faqs.pdf

Pain control advocates blasted the move, saying the document was
needed guidance for physicians who feared prosecution in prescribing
the powerful drugs.

The dispute is the latest chapter in a long running battle between
groups that promote appropriate use of pain medication and the DEA.

Effective medical pain treatment SHOULD be a human right. In fact,
allowing people to suffer pain untreated is equal in many ways to
physical torture. Under treatment of pain is a fact and the DEA owns
much of the responsibility for it.

Decisions on proper levels of pain medications should be a private
matter between patients and their physicians. Leaving the DEA as
final arbiter of the line where responsible use ends and illegal
diversion begins is a bad idea. Even when such guidelines exist — as
they did for a few days until the DEA removed them from their website
— the idea that law enforcement should be making medical decisions is

Please consider writing a letter to the editor of the Washington Post,
and to your local newspapers. The problems caused by the DEA and law
enforcement for pain specialists and their patients has had much press
over the past months. Thus a letter about the short lived DEA
guidelines may be well received by any newspaper. You may find letter
to the editor contacts for your local newspapers at:

Many chronic pain related news clippings may be found at this link

If you support a defined set of guidelines, express your demand that
the DEA produce such a list immediately so as to reduce doctor
confusion and to lower the chances that either a patient or doctor
will be unduly charged as drug criminals. If you believe the DEA
should not have such overall power to intrude on doctor/patient
relationships using pre-set guidelines, express your demand that the
DEA desist from charging either doctors or patients as drug criminals
without first having direct evidence of illegal diversion by one or
both parties.

Thanks for your effort and support.

It’s not what others do it’s what YOU do


The Washington Post article:

Pubdate: Thu, 21 Oct 2004
Source: Washington Post (DC)
Copyright: 2004 The Washington Post Company
Contact: letters@washpost.com
Author: Marc Kaufman


The Drug Enforcement Administration has reversed its support for a set
of negotiated guidelines designed to end a controversy over the
arrests of hundreds of pain specialists who prescribed powerful
narcotics for their patients. The agency took the document off its
Web site earlier this month, less than two months after announcing it
with great fanfare.

In rescinding its endorsement, the DEA wrote on its Web site that the
31-page document “contained misstatements” and “was not approved as an
official statement of the agency.” The agency declined to give any
more specifics, saying that it hoped to issue a statement “in one or
two weeks.”

Worried doctors who had worked on crafting the “consensus” document —
written over the past year by DEA officials and prominent pain
management specialists — criticized the agency’s unannounced decision
to disavow it. They said they were given no explanation or told
whether the agency had changed its position on the contentious
question of when and how doctors can prescribe the popular painkillers
without risking prosecution.

Advocates for aggressive pain management said the DEA’s decision
appears to have been triggered when defense lawyers tried to introduce
the guidelines in the upcoming drug-trafficking trial of William
Hurwitz, a McLean physician.

In late September, Hurwitz’s defense team sought to introduce them as
evidence. Several weeks later, the DEA took the document off its Web
site and said it was not official policy.

Twelve days after that, U.S. Attorney Paul J. McNulty, who is
prosecuting Hurwitz, filed a motion in the case asking that the
guidelines be excluded as evidence, again saying that they do “not
have the force and effect of law.”

“It seems pretty clear that they felt they had to try to get rid of
the guidelines because they supported so many parts of our case,” said
Hurwitz’s defense attorney, Patrick Hallinan. “If the Justice
Department followed the guidelines, there would be no reason to arrest
and charge Dr. Hurwitz.” The case is scheduled for trial Nov. 3.

DEA spokesman Ed Childress said the agency intends to rework the
guidelines and publish them again. He said he could not comment on
whether the decision to remove them had anything to do with any legal

The guidelines, which were published in August in the form of a
“Frequently Asked Questions” feature prominently displayed on the DEA
Web site, were described at the time as an effort to codify the
“balance” that both the DEA and the pain management community have
long said they are seeking.

The DEA has complained in the past that irresponsible, and possibly
criminal, doctors prescribed narcotic painkillers too frequently and
without enough care — letting the valuable drugs get into the hands
of people who sell them, abuse them and sometimes are harmed by them.

But many pain specialists have watched with dismay as scores of
colleagues were arrested on criminal charges based on what many
believe was at worst negligent or sloppy prescribing practices. Many
of the cases triggered mandatory sentencing guidelines that can send
convicted drug dealers to prison for decades.

The introduction of long-lasting prescription opioids such as
OxyContin revolutionized the treatment of pain, which doctors say is
greatly under-treated in the United States.

Researchers say a small percentage of patients become addicted, but
most people in pain do not. However, OxyContin and other powerful
drugs became popular with drug abusers in the late 1990s, especially
in rural and southern areas, and it has been linked to numerous
hospitalizations and some deaths.

The consensus document was the product of more than a year of work by
Russell K. Portenoy, a leading pain expert with New York’s Beth
Israel Medical Center, University of Wisconsin pain specialist David
E. Joranson, professionals involved in the care of dying patients,
and two top officials of the DEA.

When the guidelines were made public, DEA Administrator Karen P. Tandy
embraced them and said in a statement: “The medical and law
enforcement communities continue to work together to carefully balance
the needs of legitimate patients for pain medications against the
equally compelling need to protect the public from the risk of
addiction and even possible death from these medications. . . .
The DEA is committed to assisting the overwhelming majority of health
care providers who successfully strike that balance every day, as well
as the law enforcement officers investigating diversion and abuse of
pain medications.”

Portenoy said the group worked closely with the DEA, responding to
many of its concerns and revising drafts many times to accommodate the
agency. Portenoy said agency officials were active in the entire
process, and he said he strongly believed that there had been
“complete buy-in from the upper echelon” of the DEA regarding the guidelines.

Since word went out the guidelines had been withdrawn, he has received
many calls and e-mails from worried and upset doctors, Portenoy said.

“There was a real feeling that we had made significant progress, but
now we have to wonder whether that progress is all gone,” Portenoy
said. “If they don’t fix whatever problems they might have and put
the document back up, that would speak very clearly that the goal of
the DEA is not to collaborate with the medical community or to
reassure doctors about the proper role and use of prescription opioids
in pain management.”

The guidelines were also on many Web sites for pain clinics and
programs. The DEA called at least one of them, the Pain & Policy
Studies Group of the University of Wisconsin, and asked it to remove
the document.



Note: This is a sample only. Please write your own letter! Newspaper
editors are well aware attempts to have many people send them form letters
for publication, and reject those attempts. See, for example, this article
on letter writing published yesterday:


The Drug Enforcement Administration continues to delay the release of
guidelines for use by medical doctors who prescribe pain medications.
Every day that passes without those guidelines being well-defined and
available to all MDs is another day that doctors are put at risk of
being arrested by DEA agents and charged with one or more drug crimes.
Without well defined rules for prescribing opiates, such arrests can
occur even though the doctor is following established medical
procedures and has no intent to either over-prescribe pain medicine or
to see them be illegally diverted to unqualified users.

Considering the harsh and punitive legal sanctions that can be levied
against any American convicted of a federal drug crime, not having an
accepted set of federal guidelines from the DEA also puts patients’
legitimate medical needs at risk. Doctors confused by constantly
changing and/or non-existent federal rules will likely lean to
minimizing dosage levels in order to protect their own liberty even
when they might know the patient could benefit from a different level
of care.

It’s time for the DEA to settle the confusion for all concerned. If
they continue to delay, the health of patients and the liberty of both
patients and doctors are both at undue risk.


ADDITIONAL INFO to help you in your letter writing efforts, Please See:

Writer’s Resources http://www.mapinc.org/resource/


email messages, etc.)

Please post a copy of your letter or report your action to the sent
letter list (sentlte@mapinc.org) if you are subscribed, or by
E-mailing a copy directly to MGreer@mapinc.org if you are not
subscribed. Your letter will then be forwarded to the list so others
can learn from your efforts and be motivated to follow suit.

This is _Very_ Important as it is one very effective way of gauging
our impact and effectiveness.

Subscribing to the Sent LTE list (sentlte@mapinc.org) will help you to
review other sent LTEs and perhaps come up with new ideas or
approaches as well as keeping others aware of your important writing

To subscribe to the Sent LTE mailing list see http://www.mapinc.org/lists/index.htm
and/or http://www.mapinc.org/lists/index.htm#form do


Prepared by: Stephen Heath, MAP Media Activism Facilitator

= Please help us help reform. Send drug-related news to