PAIN PATIENT - MY DRUGS ARE MY BUSINESS

John Grim is tired of staying quiet about his pain and the medicine
he takes to control it. He's fed up with the stigma surrounding the
thousands of patients like him who use narcotics for legitimate
reasons. And he's outraged that state regulators want to set up a
computer database that would track every prescription he fills.

"I'm worried about scrutiny from people who have no business snooping
into my medical issues," he says.

Grim is sitting at a cafe table near his home in Des Moines. He leans
forward onto his forearms, grimacing as he shifts weight off his
ruined back. "Do I look like a junkie to you?" he asks.

He looks like a typical Iowan. He is 47, and he used to be a
corrections officer in the state prison system. He was placed on
disability after rupturing a disc in his back while restraining an
inmate nine years ago. He's undergone nine surgeries, and he expects
more. He clutches a gray, plastic remote control for an electronic
implant that helps block pain signals from traveling up his spinal cord.

Every four hours, he takes narcotic pain relievers. He is not an
addict, he says. He gets no high off the pills. "I'm physically
dependent on them - just like a diabetic is physically dependent on insulin."

Grim says he takes no pleasure in talking about these things
publicly, but someone has to step out of the shadows and show how
normal a pain patient can be.

He has been following closely a proposal to have the Iowa Board of
Pharmacy Examiners set up a computerized system, which would
automatically track every order pharmacists fill for addictive
medications. The idea was approved last spring by the Iowa House, but
it bogged down in the Senate amid privacy concerns raised by doctors'
groups. Now the proposal is back before legislators after supporters
altered it to address some of the complaints.

Under the revised plan, government officials could not perform random
searches for patients who were buying unusually large amounts of
drugs. Officials could look at the registry only if they could show
"probable cause" to suspect that a specific person was doing
something wrong. Supporters of the computer system say it mainly
would be used by doctors and pharmacists, who could check it to see
whether patients were duping multiple physicians into prescribing the
same drugs.

Grim is not mollified by the changes in the proposal. "I have no
faith," he says. "There's no way they can convince me that law
enforcement isn't going to find a way to peruse these records."

His main concern is that the system would make doctors wary of
prescribing narcotics, because they would fear being targeted by
regulators and police. He recalls how his first surgeon refused to
give him anything stronger than Tylenol 3 . "All he would do is pat
me on the shoulder and say, 'God bless you. I'm sorry I can't carry
your cross for you.' "

Grim agrees with registry supporters who say some drug addicts
"doctor shop" to obtain excessive amounts of narcotics. But he doubts
the problem is widespread, and he says if addicts couldn't get a fix
that way, they would find another source. Meanwhile, he says, the
registry could make life harder for law-abiding people like him.

He likens the proposed system to a computerized registry that would
track how Iowans spend their money. Such a system could spot people
who make foolish, unaffordable purchases, he says. But why would that
be the government's business? "Who are they going to pick on next,
that's what I want to know."