THE WAR ON DRUGS LETS PROSECUTORS PLAY DOCTORS

After I wrote last year about Richard Paey, the wheelchair-bound
patient who's been in physical agony for two decades, a lot of readers
asked me what kind of monster could have prosecuted him for obtaining
painkillers. If you watched "60 Minutes" Sunday, you could see for
yourself.

Scott Andringa, the prosecutor in Florida who sent Paey to prison for
25 years, did not come off well on "60 Minutes," but he didn't look
dementedly evil, either. He seemed exactly the way I've found him in
interviews: earnest, conscientious, convinced he had done the right
thing. That's why he scares me.

He's one of the many well-meaning public officials whose judgment has
been so warped by the war on drugs that they can't see what they've
become. Andringa, echoing the line of the Drug Enforcement
Administration, has assured me he would never stop patients from
getting medicine for their pain.

"I have the utmost respect for doctors who try to treat pain humanely
and responsibly," he told me. "I am not a doctor. I have never
claimed to be a doctor."

Yet there he was playing doctor on "60 Minutes" to explain why it was
"reasonable" to infer that Paey was a drug dealer. There was no
evidence that Paey had sold any of his painkillers ( and agents had
conducted surveillance of him and his wife for two months ). But
Andringa inferred that Paey must have been selling them because the
prescriptions he received worked out to about 25 pills per day.

"One pill every hour, every day, for two years," Andringa told Morley
Safer, as if this feat of math proved his case. It's the same mystic
numerology you hear over and over from drug warriors like Karen Tandy,
the head of the D.E.A., who prefers to focus on the number of pills
prescribed without bothering with details like the patient's needs or
the dosage.

Paey had no trouble explaining to me why he was taking 25 pills per
day: his doctor cautiously gave him a variety of low-strength pills in
order to avoid prescribing the kind of painkillers that tempt drug
abusers and invite investigation from the D.E.A. Instead of taking a
few high-strength oxycodone pills, Paey took a cocktail of pills
containing low doses of oxycodone and other less effective pain
killers like Tylenol.

As a result, the total daily dose of oxycodone in all those pills Paey
took was less than what he could have gotten in a single high-strength
OxyContin pill. And there are some chronic-pain patients who need 10
of those high-strength OxyContins every day because they, like Paey,
have developed a tolerance to the drug over the years.

So there was no good medical reason to assume that Paey wasn't taking
all those pills. In fact, he says he wasn't getting enough pain
relief because of his doctor's fear of the D.E.A. Yet Andringa simply
made his own medical diagnosis -- too many pills -- and proceeded to
exploit the extraordinary leverage that prosecutors have been given
over doctors and patients.

The typical approach is to put pressure on patients to turn on their
doctors, but it can work the other way, too. Paey told me he was
offered a deal by investigators: "They said if you're willing to
testify against your doctor it would go a long way to having these
charges go away." Paey refused, and then found himself facing hostile
testimony from the doctor, who said he had not authorized the
contested prescriptions.

After the doctor's credibility was challenged in court -- he was
contradicted both by his own words and by pharmacists who said he'd
approved the prescriptions -- the prosecutor came up with a mind-
boggling new argument against Paey. Andringa told the jurors that
even if they believed the doctor had prescribed the drugs, Paey should
still be convicted because the doctor should never have written the
prescriptions.

Andringa argued that the doctor wasn't practicing proper medicine --
according to the prosecutor's standards -- so the prescriptions were
illegal and Paey shouldn't have filled them. By this logic, instead
of listening to his doctor, Paey should have tried to anticipate what
a prosecutor would prescribe for him.

I spoke to Andringa yesterday, after he'd watched "60 Minutes" and
seen Paey's wife and the three teenage children whose father may die
in prison. "I'm not thrilled about this case," he said. "I'm only
proud that I did my job as a prosecutor." And self-appointed doctor.