Specialists Decry DEA Reversal on Pain Drugs

The Washington Post ^ | December 21, 2004 | Marc Kaufman

[neverdem]

New Rules Called A 'Step Backward'

Three medical associations representing pain specialists have sent the Drug Enforcement Administration an unusual joint letter sharply critical of its recently revised guidelines on prescribing pain medicines.

The letter, signed by the presidents of all three groups, called a DEA policy statement published in November in the Federal Register "an unfortunate step backward" that encourages a return to "an adversarial relationship between [doctors] and the DEA."

Already concerned about what they saw as sometimes over-aggressive prosecutions of doctors, pharmacists and other health professionals who prescribe narcotic painkillers such as OxyContin, the specialists said the new DEA position threatens their ability to provide care to millions of patients.

The presidents wrote that despite the DEA's assurances that it does not want to discourage doctors from providing proper narcotic medication to people in pain, the new guidelines "will undoubtedly have the exact opposite effect on any practitioner reading them."

DEA spokesman Bill Grant said in response that the agency "wishes to reassure the public that the withdrawal of the August [statement] does not represent any change in DEA's investigative emphasis or approach. Physicians acting in good faith and in accordance with established medical norms should remain confident that they may continue to dispense appropriate pain medications."

He said the DEA is working on a process to gather the views of the medical community as it refines its policy.

The letter from the heads of the American Pain Society (APS), the American Academy of Pain Medicine (AAPM) and the American Society of Addiction Medicine (ASAM) is a response to a Nov. 16 DEA statement that repudiated some parts of a jointly negotiated set of guidelines that had been introduced with fanfare in August.

The August guidelines -- in the form of answers to 29 frequently asked...

[Giliad]

"Newbie here. I don't want to appear unsympathetic to pain but legal or illegal the treatment of non-cancer pain with those wonderful new oral opiates such as Oxcycontin has been a gold mine for the Methadone clinics and the coroners around the country. It is wonderfully addicting and creates a need for itself. You can't get better than that." I agree oxycontin was created for terminal illness, not every day use. However, these new rules don't just affect that drug. They affect all narcotics used to treat pain. Even the ones that are appropriate for chronic pain in non-terminal patients. I've had 4 back surgeries and 1 brain surgery and am fused from T9-S1. My pain management includes some narcotic medication. Pain managment doctors know how to treat pain without letting you get addicted. It's easy for people who don't have pain to say things like "some people have to sacrifice for the war on drugs". They aren't the ones in pain. Quality of life has to be a part of medical care. If you ever have chronic pain, you'll quickly realize that.

[Ethrane]

"I think the policy should be very simple. Doctor's who prescribe narcotic pain medicine should have a standard one page form to give to patients describing the possible harmful side-effects of narcotic pain medicine (i.e. dependence and addiciton). A signed copy of said form should provide the doctor with complete protection from government action for prescribing pain medicine."

Most pain management specialists that I know of do this....we call it a "narcotic contract". It also specifies other things, such as that the patient agrees to have his narcotic regimen managed by only that particular physician.

This step was almost made necessary by the fear of federal and state agents prosecuting physicians in their attempt to alleviate chronic pain.

I wouldn't practice these days any other way...

[Amore]

I second your sentiments. I've had to deal with doctors who were so worried about over prescribing that they'd rather let their patients be in pain. This is a really sore subject with me, if you'll pardon the pun.

[EEDUDE]

I was on OxyContin for 2 years for back problems. 120 mg per day.

Once I got the back problem resolved, I no longer needed the narcotics. The pain clinic I went to tapered me down over a 2 week period. Not pleasant, but not as bad as I expected.

That was over 2 years ago and I have not needed or wanted any narcotics since.

Properly used, these drugs are safe and effective.

Dependence which ALWAYS occurs is different from addiction, which is a psychological need for the drug.

There is WAY too much hysteria about narcotics, and when you need them, you need them.

Regarding non-cancer pain, when nerves are pinched or damaged, the pain can be every bit as intense as cancer pain.

Limiting the use of these drugs to cancer patients only is inhumane.

[Shisan]

Perhaps you are right. I am sure a certain number of people
can take controlled amounts of these drugs for a period of time but many cannot. (I have read of it being as high as 90% cannot). You were motivated and have done well. I get a skewed sample in the work I do with those who cannot and tend toward pessimism.

[EEDUDE]

I also have a friend down down in Alabama who has had a total of 4 spinal surgeries as the result of an auto accident.

She was in constant pain and totally unable to function unless she was on 500 mg of MS Contin per day plus medication for breakthrough pain.

She now has a pump implanted that's delivering 5mg morphine/day directly into her spinal canal. She's doing great and now able to get out and look for work. (She has a PhD in psychology)

An interesting fact is that after a week on the same dose of OxyContin or any other narcotic I was on there is no "high".

People that really get strung out on OxyContin are people who either snort it or shoot it. In other words, intentionally abusing it.

The pain clinic I went to was REALLY strict. Random tests to make sure you were not on any other med than what was prescribed. Random tests to make sure you were taking what WAS prescribed.

Show up positive for any illegal substance or get a DUI and you were OUT on your ass.

I just hate that the DEA is making it so hard for legitimate pain patients and Doctors, when the price of heroin on the street is at an all time low and the purity at an all time high. (source DEA)

Pain patients and Dr's are just an easy target in my opinion.

[Judith Anne]

Thanks for posting. I really wish that non-medical people would get out of the doctors' business.

Honestly, as far as I'm concerned, pain assessment and adequate treatment are as important to patient health as any other single factor.

[Shisan]

What they were doing by being so strict was conveying to you the potential for harm of the drugs you were receiving.
That means they cared. Many out there prescribing narcotics do not care enough to let the patient know and many patients run into trouble accidently, as it were.
I have always felt that the DEA and the FDA are bloated, inefficient bureacracies and I would not interfere with the doctor-patient relationship (if it exists) but the indiscriminate prescribing of pain meds is like giving a child a loaded gun.

[Amore]

"I can only wish these bastards a year or two of chronic pain which could be treated by drugs but won't be because of government interference."

Thanks, you've stated my feelings very nicely.

[chilepepper]

the purpose of the war on drugs is to provide funding for the DEA, and to increase government power. check the long list of civil liberties set aside to support the "war on drugs".

like a chinese finger puzzle, the harder you crack down on drugs, the more valuable the payoff to those who sell. its the capitalist system. the BIGGEST backers of the war on drugs are the drug lords -- think about it.

the DEA is completely oblivious to the needs or desires of society, and would allow the entire population of the US suffer rather than to allow people in pain to have a minutes respite.

this just to follow a puritan mandate which busy-bodies use to involve themselves in the lives of others...

[rhombus]

the purpose of the war on drugs is to provide funding for the DEA, and to increase government power. check the long list of civil liberties set aside to support the "war on drugs"...

this just to follow a puritan mandate which busy-bodies use to involve themselves in the lives of others...

You nailed it. Check out any thread on this site with the word "marijuana" in its title and see the usual busy-body drug warriors with their bad assumptions, bad data and all around bad attitudes pummeling anyone who dares have an opinion that it just might not be anyone's business but their own.

Who are we trying to fool? We LOVE drugs in this country... it's what we teach our children every day with beer drinking for sport, multiple exotic hayfever drugs, pretty anti-cold capsules rolled out every winter...this time with the "extra-strength" pain releaver. Now we have can buy drugs for instant erections and to keep us from wetting our pants. If you are having trouble paying attention, try out this new citrus-colored pill to help you focus. Sheesh! The war on drugs? Don't make me laugh, a huge waste of time and money and just a way to funnel federal cash to cops.

[Smokin' Joe]

Pain is a versatile human resource management method that governments do not want to relinquish control over.

Ever.

You got that right!