DEA REVISES RULE ON PRESCRIBING PAINKILLERS

Doctors Freed to Write Multiple Prescriptions

The Drug Enforcement Administration yesterday overturned a
two-year-old policy that many pain specialists said was limiting
their ability to properly treat chronically ill patients in need of
powerful, morphine-based painkillers.

While defending its efforts to aggressively investigate doctors who
officials conclude are writing painkiller prescriptions for no
"legitimate medical purpose," the agency agreed with the protesting
experts that it had gone too far in limiting how doctors prescribe
the widely used medications.

The unusual turnaround was welcomed by relieved doctors, who said it
will help restore "balance" in government policy between the needs of
pain patients and the effort to control prescription drug abuse and diversion.

Specifically, the DEA proposed a formal rule that would allow doctors
with patients who need a constant supply of morphine-based
painkillers to write multiple prescriptions in a single office visit.
Under the new rule, a doctor can write three 30-day prescriptions at
a time -- two of them future-dated -- to be filled a month apart.

Two years ago, the agency clamped down on the common practice of
writing such multi-month prescriptions, which it said were probably
illegal and were contributing to the growing abuse of prescription painkillers.

As a result of the DEA's position, many doctors began requiring
patients to come in each month for a new prescription -- office
visits many doctors considered medically unnecessary but essential to
keep them out of trouble with the DEA.

Yesterday, DEA Administrator Karen Tandy said the agency had been
wrong in limiting the multiple prescriptions and had made the tough
decision to reverse course. She said the DEA received more than 600
comments from doctors, patients and others about its policies on
narcotic painkillers, many of them strongly opposed to the agency's
position on limiting refills.

"Think about how hard it is for anybody to go out publicly and say,
'We think this is probably prohibited by law,' " she said, referring
to the earlier decision to prohibit multiple refills. "And then you
listen to people and then you say, 'You know what? You're right,' and
we're going to propose a rule that interprets this correctly. And
that's what we've done."

When the DEA issued its restrictive 2004 drug refill guidelines, many
pain specialists saw it as a sign that relations between their
profession and the agency had deteriorated badly. They also
complained that DEA arrests and prosecutions of doctors treating pain
were creating a "chill" on medical practice and denying patients
drugs they needed.

Agency officials had earlier worked for two years with pain and
hospice experts on a "frequently asked questions" guideline to advise
doctors on how to prescribe controlled drugs in a way that would not
get them into trouble with law enforcement. The agency briefly posted
the guidelines on its Web site in 2004 but then pulled them down and
disavowed them.

One of the doctors involved with writing the guidelines -- who became
a critic of the DEA when they were abruptly discarded -- called
Tandy's actions yesterday "a very positive step forward in restoring
that necessary cooperation between practicing physicians and the DEA."

Howard Heit, a Fairfax County pain and addiction specialist, also
said the new policy will help patients get better care by allowing
doctors more flexibility in prescribing controlled drugs.

But Siobhan Reynolds, who created the Pain Relief Network several
years ago to help defend pain doctors who she said were being
unfairly arrested and prosecuted, disagreed and said the new DEA
policy has changed little.

"Ms. Tandy states here, as she has on many occasions, that doctors
need not fear criminal prosecution as long as they practice medicine
in conformity with what these drug cops think is 'appropriate,' "
Reynolds said. "If that isn't a threat, it will certainly pass for
one within the thoroughly intimidated medical community."

The use of prescription narcotics rose sharply over the past decade
as knowledge grew on how to control intractable pain and specialists
found what they considered better ways to help patients. That growing
use, however, has led to abuse as well, and to scores of deaths and
injuries associated with prescription narcotics.

In addition to publishing its new policy statement and rulemaking
yesterday, the DEA began posting extensive information on its Web
site about doctors who have been arrested and prosecuted for their
prescribing practices. Tandy said that she hopes doctors will review
the cases so they will see that only "egregious" offenders are being
prosecuted.