A VICTORY OF PAIN?

And you thought the war on drugs was about keeping cocaine out of the
country and heroin out of the kids. Guess again.

If the bill that flew out of the House last week becomes law, those
intrepid folks at the Drug Enforcement Administration will be given
encouragement to go after doctors as if they were dealers.

The bill was titled, in the best Orwellian fashion, the Pain Relief
Promotion Act. In fact, it was a buffed and shined up version of last
year's loser, the Lethal Drug Abuse Prevention Act.

Both bills to prevent the use of federally controlled substances by doctors
assisting suicides were deliberately aimed at overthrowing the law approved
by the voters in Oregon. But this year the sponsors added a few bucks for
pain management and changed the name. They convinced their colleagues that
this was an easy way to oppose doctor-assisted suicide while proving you
were sympathetic to dying patients, a.k.a. "I feel your pain." According to
the sales and spin, the bill that passed wouldn't affect doctors who
prescribed substances like morphine for pain relief, even if the drug
unintentionally caused death.

But it would punish the doctors who prescribed these substances
intentionally to cause death. As Henry Hyde of Illinois declaimed, "We
believe doctors should help people cope with the pain and terror of death,
not thrust death upon them." A fellow sponsor, Charles Canady of Florida,
added, "We draw a bright line here." A bright line? The line between a dose
that controls pain for the terminally ill and a dose that ends up hastening
death is one of the murkiest in medicine. The bill doesn't say how doctors
would walk this line or how they would prove their intent.

If the companion law in the Senate passes and the whole mess survives a
states' rights test, doctors could be sentenced to 20 years in prison.
Anybody could drop a dime and the DEA could be left to decide the doctor's
motives. Joanne Lynn, the head of Americans for Better Care of the Dying,
opposes both assisted suicide and this law. But she can imagine signs
posted around hospitals saying: 1-555-CALLDEA. To put it bluntly, she says,
"ordinary record-keeping and conversations would be insufficient to protect
us from prosecution." The House bill was described by the media and the
sponsors as a litmus test on assisted suicide.

It gave Hyde et al. a chance to thumb their noses at Oregon voters, not to
mention the voters in California and Maine, where doctor-assisted suicide
is going on the ballot.

But ironically, the law wouldn't actually ban all assisted suicide; it
would just prohibit the use of certain barbiturates. Remember Jack
Kevorkian? He used carbon monoxide in his "practice." There are plenty of
uncontrolled substances that can end life.

The bill for "pain relief" could,however, increase pain. Says Oregon
Senator Ron Wyden, another opponent of both assisted suicide and this bill:
"The undertreatment of pain is a documented crisis.

If the DEA can second-guess doctors who are already reluctant, we'll see
pain relief programs set back." Two months ago, for the first time, a
pulmonary specialist was disciplined for undermedicating patients.

We know that in the last week of life, a third of all people suffer
moderate to severe pain. This pain is a cause for the despair that
underlies many requests for a merciful death. In the past several years,
with all the discussion about the end of life, Oregon has actually pulled
ahead of the country in both hospice care and pain management. Only one in
10,000 Oregon deaths have been assisted suicides. Indeed, it's possible
that the rate is lower in Oregon than in states where it's still clandestine.

If our friends in Congress were actually interested in pain relief rather
than political grandstanding, there are two other bills - the Compassionate
Care Act and the Conquering Pain Act - that would build family support
networks, fund centers for pain management research, and require report
cards on treatment for pain. Neither is given a chance of passage. In the
past years the war on drugs has done enormous collateral damage to sick
civilians.

We keep marijuana from cancer patients, heroin from the dying. Now the
House of Representatives wants to encourage the DEA to sniff around
doctors' prescriptions of barbiturates. And the Senate may follow. Whatever
happened to that old slogan of the drug war "Just Say No"?