DEA doctors the evidence

MAP archives a terrific article by the AARP from the latest issue of their magazine on Prisoners of Pain. It's on the long side but worth reading in full. For those who never do, however, here's a few choice quotes.

With that conversation, Hamalainen joined legions of patients who are the victims of a troubling and all-too-common medical practice: the undertreatment of significant and debilitating pain. An estimated 75 million Americans suffer from chronic pain, according to the American Medical Association, and numerous studies have shown that patients often don't receive the medication that could provide relief. Undertreatment runs as high as 50 percent among advanced-stage cancer patients and 85 percent among older Americans living in long-term care facilities.

...Worse, some physicians fear that if they deliver humane pain care, they'll face prosecution by the federal Drug Enforcement Administration ( DEA ) or state medical boards. In recent years, a number of respected doctors have been investigated and even prosecuted after prescribing large amounts of opioids. The result, according to experts, is an environment that scares doctors away from practicing good medicine.

...At Memorial Sloan-Kettering Cancer Center, where he launched his career as a researcher and pain physician, Portenoy initially concentrated on cancer pain. Eventually he discovered that opioid medicines routinely prescribed in advanced-cancer cases also worked for patients without terminal illnesses. They relieved the symptoms without fogging patients' brains or turning them into addicts. The only major ongoing side effect, constipation, was manageable with other drugs. But when Portenoy shared the news in a 1986 journal article, he received excoriating criticism from his colleagues.

Slowly, time has proven Portenoy correct. In 1996 two leading professional groups declared opioids "an essential part of a pain-management plan." Five years later, the DEA and 21 health organizations agreed that opioids are often "the most effective way to treat pain and often the only treatment option that provides significant relief."

Though the DEA wouldn't comment for this article, it has previously insisted that it only goes after bad apples. "Our focus is not on pain doctors. Our focus is on people who divert drugs," agency official Patricia Good said during a 2004 teleconference. But physician groups and patient advocates point to a growing list of respected pain doctors who have been prosecuted by the DEA and by state medical boards. They say that while the DEA has a legitimate interest in preventing the diversion of harmful drugs, the agency's adversarial zeal has grown in the past four or five years.

Of course the seminal work on this matter has been published in a report commissioned by Radley Balko of the Cato Institute.

Don't let the DEA fool you. It is a war on doctors and it has nothing to do with drug diversion. They just make easy targets who have lots of assets to seize under forfeiture laws.