DRUG CRACKDOWN PAINS PATIENTS

Chronic Sufferers Say They Find It Harder to Get Relief

The government's widening crackdown on prescription-drug abuse is
having an unintended consequence: It's making it tougher for people
with chronic pain to get treatment.

In recent weeks, federal regulators have sharply dialed up their
effort to combat the black market in pain killers. The White House
Office of National Drug Control Policy this month announced a $148
million plan targeting illegal use of prescription tranquilizers,
sedatives and other drugs, with a goal of curbing the flow of drugs
such as OxyContin to abusers.

Separately, the Drug Enforcement Administration is reviewing a
proposal to reclassify hydrocodone, the most commonly prescribed pain
drug in the United States, in a more tightly regulated class of drugs.
If the switch occurs, patients would be unable to get refills without
obtaining a new prescription from a doctor.

State regulators are stepping up their own efforts as well. Some 20
states already have implemented some form of prescription-monitoring
plan to help track doctors who prescribe narcotics, the DEA says.
Lawmakers in at least six more states are considering similar plans.

The problem is that many of the opium-derived prescription drugs that
can successfully treat severe chronic pain - such as oxycodone and
hydrocodone - also command high premiums on the street market. Rising
abuse rates, and the media frenzy generated by celebrity addiction
cases like Rush Limbaugh's, have increased pressure on regulators.

Patients with chronic pain say the government initiatives are making
it harder for them to get the painkillers they need to battle
conditions such as arthritis and cancer. The crackdown is making
doctors more reluctant to prescribe some drugs out of fear they will
attract attention from regulators.

Doctors are also getting more vigilant. One Tennessee doctor turned in
a patient he believed wasn't actually taking a prescription
painkiller. The arrest took place in the doctor's office.

The DEA has been aggressively prosecuting doctors who prescribe large
amounts of painkillers that wind up on illegal markets. The agency is
trying to reduce the number of so-called pill mills - unscrupulous
doctors who write prescriptions for narcotics to anyone who asks. The
DEA has arrested 50 doctors in the year that ended last September, for
issues related to improper prescribing, including five cases where
doctors allegedly were trading prescriptions for sexual favors,
according to the DEA.

"Doctors can't be pill pushers," says Bob Williamson, deputy chief in
the office of diversion control at the DEA. "Legally, they are treated
like drug dealers."

Doctors say the prosecutions are ensnaring legitimate physicians.
Advances in the way doctors treat chronic pain during the past decade
have led to more use of opioids, in higher doses, as part of an
aggressive approach in difficult pain cases.

The trouble began when Oxy Contin hit the market in 1996. Most
traditional pills have just a few hours' worth of opioids, but it used
a time-release formula that jammed 12 hours' worth into one pill. That
meant patients could get consistent relief for long stretches of time
- - without the roller coaster pain-relief cycle that can be caused by
drugs that wear off more quickly.

But abusers quickly realized they could grind up the pills - defeating
the time-release formula - and inject or snort the powder to get a
massive hit of the drug all once. By the late '90s, OxyContin was a
favorite on the street market.

The practice of prescribing drugs such as these carries increasing
legal risks for doctors. If a patient turns around and sells the
drugs, the doctor can be held legally responsible, according to the
DEA. Doctors also can be charged if a patient abuses a drug. In 2002,
a Florida doctor was convicted of manslaughter after four patients
died from OxyContin overdoses. The case is being appealed.

The DEA doesn't necessarily need to prove a doctor operated with
explicit criminal intent to bring charges. Instead, they must
demonstrate the doctor prescribed drugs "outside the scope of
legitimate medical practice." That standard is open to a range of
interpretations.

The prosecutions worry pain doctors. "I'm terrified," says Dennis
Ford, a specialist in Chattanooga, Tenn., who has drastically cut back
his OxyContin prescriptions. Instead he prescribes other drugs, such
as morphine and pain patches, that he believes are less likely to draw
attention from regulators. The drugs are just as strong as OxyContin,
but the street value is lower.

Some doctors are deciding it just isn't worth the risk to offer opioid
drugs to patients at all. "I will not treat pain patients ever again,"
says Frank Adams of Houston, a former cancer pain specialist who was
indicted on charges related to opioid prescribing in the early 1990s
following a DEA investigation. The charges were later dropped,
according to his lawyer, Henry Ackels of Dallas. Adams is now the
medical director of a brain disorder clinic in Houston.

Regulators say they are trying to take a balanced approach to protect
the public health. "I don't want legitimate patients in pain
undertreated because of fears of criminal persecution," says Karen
Tandy, the DEA's administrator.