DEA CLARIFIES PROTOCOL FOR PAINKILLERS

WASHINGTON - The federal Drug Enforcement Administration and top pain
specialists on Wednesday jointly issued detailed new guidelines designed to
reassure worried doctors that they will not be prosecuted for prescribing
high doses of powerful morphine-based painkillers for patients who need
them for intractable pain.

The guidelines also make more clear, however, that doctors have
responsibilities to ensure that their pain patients are not abusing
prescription opioids such as OxyContin and are not doctor-shopping to
collect narcotics for illicit sales.

The new document, which will be distributed to law enforcement agencies and
all doctors who apply for DEA approval to prescribe controlled drugs, is an
effort to resolve a controversy that has bedeviled pain specialists.

Patients Had Been Turned Away

An earlier consensus paper failed to clarify the issues, leading to a
situation where many pain patients have been turned away by doctors and
pharmacists concerned that prescribing and dispensing opioid painkillers
would get them in trouble with the law.

"We hope this is a step in the right direction to reverse an increasingly
unfriendly environment for pain management," said one of the authors of the
new guidelines, University of Wisconsin pain studies director David E.
Joranson.

Getting the agency to publicly describe its position on prescribing opioids
"will make more clear that the DEA understands good medicine and would be
avoiding it in their investigations," he said. "A lot of people don't feel
now that's the case."

The new guidelines spell out steps that assure proper prescribing, such as
how to diagnose severe pain and keep proper records to justify prescribing
a narcotic painkiller. Written largely in a question- and- answer form, the
document makes clear to law enforcement that even heavy use of prescription
opioids can be appropriate and that the physical dependence it brings is
not the same thing as physical addiction.

The DEA and other law enforcement agencies stepped up their prosecutions of
doctors, pharmacists and some of their employees after the prescription
narcotic OxyContin became widely used and abused in the late 1990s,
resulting in overdoses.

A Climate Of Fear

With hundreds of doctors charged in recent years, pain patients and doctors
who treat them have complained of a growing climate of fear - adding to
what is widely seen as a serious nationwide problem of inadequate pain
treatment.

Among the high-profile prosecutions of pain specialists is that of William
Hurwitz, a nationally known doctor from McLean, Va., accused of drug
trafficking. Hurwitz is scheduled to go to trial this fall.

"In numerous meetings over the past several years, it has become obvious
that there are many misconceptions about the DEA's role and even the DEA's
fundamental beliefs about the use of prescription opioids," said another
guidelines author, DEA diversion control official Patricia M. Good.

"Many of these misconceptions lead to unwarranted fear that doctors who
treat pain aggressively are singled out for enforcement actions, and that
the goals of protecting the public health from drug abuse have come into
direct conflict with the goals of promoting the public health through
effective pain control," she said. "Undertreatment of chronic, serious pain
is considered a major medical problem."

Russell Portenoy, another author of the guidelines and a pain specialist
with New York's Beth Israel Medical Center, said opioid painkillers are
appropriate treatment for serious pain from cancer, AIDS and among the
terminally ill. About 40 percent of those patients are undertreated, he said.

"What this document does is make clear [that] we in pain management and DEA
are on the same page, and that we're willing to endorse the same
principles," Portenoy said. "We need to create a culture of respect for the
policies."

The document was met with skepticism by some advocates for pain patients,
who say it will do little to calm jittery doctors or decrease the illicit
use of prescription narcotics.

"The Department of Justice and other prosecutors are misidentifying quality
pain management for drug dealing and have apparently convinced academic
pain medicine that these doctors were 'diverting drugs,' " said Siobhan
Reynolds, founder of the Pain Relief Network.