Wednesday, July 06, 2005

Politics of pain management

I've been meaning to post about this report on Treating Doctor's as Drug Dealers, commissioned by Radley Balko at the Agitator. This is an issue we've been following here for too long, as the DEA's insane policy of interfering with best medical practices has escalated. Weighing in at a hefty 28 pages, it's well worth reading if you want to understand the facts and folly of this ill-advised DEA strategy. From the report.
Untreated pain is a serious problem in the United States. The American Pain Society, another professional group, estimates that in 1995 untreated pain cost American business more than $100 billion in medical expenses, lost wages, and other costs, including 50 million workdays.

A 2003 article in the Journal of the American Medical Association puts the economic impact of common ailments alone (such as arthritis, back pain, and headache)at $61.2 billion per year.

It's a new field, only gaining acceptance in the 1980s, that now struggles to find practitioners willing to take the risk in order to treat the thousands that need the therapy. Among those doctors who treat chronic pain in or outside of the specialty, 40% report they underprescribe pain medication for legitimate patients for fear of drawing the DEA's unwanted attention. The problem has reached crisis proportions for Americans in pain.

It's estimated that "between four or five thousand doctors who specialize in pain management treat the 30 million chronic pain patients who seek treatment in the United States - about one doctor for every 6,000 patients." They are not distributed equally either. For rural patients, one might have to travel hundreds of miles to find a doctor willing to treat their condition.

The report details the problem, starting from the historical beginnings of prescription pain medication almost a century ago, to the present day DEA vendetta against practicing physicians. Public safety is not part of the equation. For instance, while there are 16,500 documented deaths from aspirin complications, there were an estimated 464 alleged oxycotin deaths and that number is suspect due to irregularities in collecting statistical data, such as ignoring the presence of multiple drugs in the patient's systems.

No, this war on doctors has its roots in the DEA's more pragmatic concern - justifying its own existence.
Until the 1990s, the DEA focused its resources primarily on illegal black market drugs, such as heroin, cocaine, crack cocaine, ecstasy, and marijuana, in urban areas.

But in 1999 the DEA came under heavy criticism from Congress on the grounds that there was no "measurable proof" that it had reduced the illegal drug supply in the country. In 2000 and 2001 the Department of Justice, which administers the DEA, gave the agency a highly critical rebuke, and asserted that the Drug Enforcement Agency's goals were not consistent with the president's federal National Drug Control Strategy.

The DEA would need to find a new front for the War on Drugs, one that could produce tangible, measurable results.
Chasing down illegal cartels is - as Bush might put it - hard work, and the results are far from guaranteed. Real drug dealers conduct their business in ways to beat the laws. Doctors are law-abiding citizens who comply with it, maintain records and conveniently keep regular office hours making them easy to find. Their assets are easily discovered for forfeiture purposes, which are then used to further finance this ill-conceived scheme.

It comes down to this. If the DEA has become so ineffective that it is reduced to allocating most of its resources to harassing physicians and the terminally ill who use medical marijuana, then it's time to revisit whether the agency is worth the taxpayer funding entrusted to it with the expectation it would pursue serious crimes against society.

They're not waging war on drugs; they're waging a war on law abiding Americans.


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