WHY IS THE DEA HOUNDING THIS DOCTOR?

The Feds Are Cracking Down On Pain Specialists, And Doctors--And
Their Patients--Are Crying Foul

On a cold morning last April, in the shadow of Montana's Beartooth
Mountain range, five agents from the federal Drug Enforcement
Administration (DEA) walked into the office of Dr. Richard Nelson, a
Billings neurologist. For six hours, they combed through his records,
seizing 72 patient charts and confiscating his drug-dispensing
permit. The charge?

None so far, but the assumption is that he is suspected of improperly
prescribing narcotic drugs.

Despite a distinguished professional record spanning more than four
decades, Nelson has had to spend $20,000 on lawyers, fearing that the
government will indict him if it turns out that one of his patients
has misused his medicine. "My practice is sunk," says the 73-year-old
physician, who specializes in chronic-pain treatment. "I can't even
write a prescription for Tylenol 3 if someone has a migraine."

The DEA, for its part, says it was acting on tips from "several
individuals in the community and pharmacies ... regarding suspicious
prescriptions," according to a spokesman, who declined to elaborate.

It's a messy situation.

No one is denying that federal and state officials, under pressure to
combat a spike in pain-killer abuse, are waging an escalating war on
drugs that is spilling into the waiting rooms of neighborhood doctors.

Over the past six years, more than 5,600 physicians from Alaska to
West Virginia have been investigated on suspicion of "drug
diversion." Some doctors allegedly prescribed narcotics too freely,
while others issued them to patients who turned out to be dealers or addicts.

More than 450 doctors have been prosecuted on charges ranging from
illegal prescribing and drug trafficking to manslaughter and murder.

But in the government's new crackdown, legitimate physicians and
patients may be getting caught in the net. "Fifty million Americans
are in severe pain from arthritis, back injuries, cancer and other
disabilities," says Dr. Scott Fishman, president of the American
Academy of Pain Medicine. "But the government is sending a message to
avoid prescribing strong pain-killers."

Ultimately, it may be the patients who get hurt most, because a
growing number of doctors, frightened of government scrutiny, are
avoiding the use of powerful narcotics such as OxyContin, Vicodin,
Percocet and Dilaudid. "It is impossible to be sure that a patient is
not diverting any of his medication," says Dr. Thomas Stinson, a
Medford, Mass., anesthesiologist who is closing his 20-year practice
to new pain patients. "I fear I might be targeted."

In the past year, hundreds of sufferers have contacted the
Baltimore-based American Pain Foundation. "They've gone to every
physician within hundreds of miles and can't get someone to prescribe
to them," says executive director Will Rowe. In some cases, patients
with high-dosage prescriptions are turned away by drug stores, which
are also subject to DEA investigations. "It's demeaning," says Mary
Vargas, a Maryland attorney whose spine was injured in an auto
accident. "Pharmacists tell me they don't have the medication, only
to recant and dispense it when I persist with the manager."

The pain wars escalated last April when Virginia internist Dr.
William Hurwitz was sentenced to 25 years in federal prison after 16
former patients testified against him and a jury found that the death
of another patient was caused by an overdose.

Hurwitz's assets were seized, and now he is appealing his conviction
with the help of the pain foundation and the Association of American
Physicians and Surgeons. Hurwitz defenders acknowledge that he may
have practiced overly aggressive medicine and allowed addicts to
snooker him, but insist he never profited from drug sales and was not
a criminal. "Maybe his license should have been suspended," says Dr.
Russell Portenoy, chairman of the Department of Pain Medicine and
Palliative Care at Manhattan's Beth Israel Medical Center. "But there
was no evidence that his patients were not in pain."

That's not how DEA administrator Karen Tandy sees it. "Dr. Hurwitz
was no different from a cocaine or heroin dealer peddling poison on
the street corner," she told reporters after his sentencing.
Prosecutors said Hurwitz prescribed "obscene" amounts of medicine to
patients he knew were addicted to cocaine and other drugs.

As for the DEA's other investigations and prosecutions, "We're not on
a witch hunt," Tandy told TIME. "We are very careful in our
investigations. More than 600,000 doctors are registered to prescribe
controlled substances. There are a very small number of bad apples."
Her agency, she says, has stepped up its investigations because of an
"explosion" of illegal-prescription-drug abuse. "People are dying out there."

The use of opioids--medicine originally derived from poppies--dates
back thousands of years.

They were widely available in the U.S. until the public, alarmed by
the growing number of addicts, called for strict anti-narcotics laws
in the early 20th century.

In the public mind, opioids such as morphine and laudanum, although
they remained the most effective pain relievers, became associated
with their illegal cousins--heroin and opium--and doctors often shied
away from prescribing them.

But opioids made a comeback in the 1980s, after patient groups and
physicians focused attention on the problem of under-treated pain.
Research showed that addiction did not necessarily result from
aggressive, well-managed opioid therapy.

In the 1990s, as the specialty of pain management grew in hospitals
and universities, opioid use spread from cancer and end-of-life
patients to the chronic-pain victims of industrial accidents, car
crashes and conditions such as migraines, diabetes and rheumatoid arthritis.

But as local internists began to prescribe stronger pain-killers for
regular patients, some of those drugs--no one has reliable
figures--began to flow into the black market, whether through
pharmacy and warehouse theft, Internet sales or the scamming of
legitimate doctors.

When OxyContin, a time-release version of the opioid oxycodone, was
introduced in 1995, drug addicts learned to grind up the pills to get
a quick, intense high; in pockets of Appalachia, Maine and Ohio,
OxyContin became the drug of choice. Meanwhile, celebrity
abusers--including Rush Limbaugh and Courtney Love--sparked a flurry
of publicity, leading politicians to push for a crackdown on what was
being called an epidemic of prescription-drug abuse.

But the dimensions of that epidemic are in dispute--and from
unexpected quarters.

Last week a spokesman from the White House Office of National Drug
Control Policy warned TIME that while prescription-drug abuse is a
serious problem, and growing among teens, the numbers in a highly
publicized study from Columbia University's National Center on
Addiction and Substance Abuse are "not a reliable estimate." The
survey describes a near doubling of prescription-drug abuse from 1992
to 2003, but because of changes in the way federal statistics were
gathered in the past decade, no such claim can be made, the spokesman
said. Last month the libertarian Cato Institute issued a report,
Treating Doctors as Drug Dealers: The DEA's War on Prescription
Painkillers, charging that the agency exaggerated reports of
OxyContin deaths and overdoses.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and
ibuprofen, which can lead to intestinal bleeding, cause 35 times more
deaths a year than OxyContin, the Cato report contended, and are far
less effective.

The DEA's $154 million drug-diversion campaign is also under attack
by state officials.

In a stinging 10-page critique issued last March, 32 state attorneys
general, led by Oklahoma's Drew Edmondson, charged that the agency's
proposed criteria for investigations would force severely ill
patients to make frequent, unnecessary doctor visits, thus increasing
both their hardship and their co-payments. "DEA is creating a climate
that ... discourages good practice," they wrote. Tandy met with a
delegation of attorneys general in April to reassure them that "the
last thing DEA wants to do is to chill the legitimate prescription of
pain medications," promising that new rules would balance medical and
legal concerns.

Meanwhile, 25 states are taking the initiative, mounting their own
electronic systems in pharmacies to catch suspect patients.

As the national debate plays out, Nelson, the Montana neurologist,
remains under investigation. He describes himself as a cautious
prescriber. A graduate of Washington University School of Medicine in
St. Louis, he also trained with the American Academy of Pain
Medicine. He required that his patients sign a four-page, 21-item
contract before getting any opioid treatment, pledging, for example,
that they had never received a diagnosis of substance abuse or been
involved in drug dealing, that they would not seek to replace lost
medication or obtain early refills and that they would buy their
drugs from only one designated pharmacy.

Monthly checkups and extensive tests--including MRIs and
electromyographic studies--were the norm, Nelson says. Over the
years, he has dismissed more than 70 patients for not following his rules.

Since the DEA raid, many of Nelson's patients have been unable to find doctors.

Few physicians are trained in the complexities of pain control, and
fewer still want to risk government second-guessing. Some of Nelson's
patients have suffered acute narcotic-withdrawal symptoms, as he was
unable to wean them gradually.

Others, unable to cope with their pain, lost their jobs. They have
staged demonstrations and press conferences in downtown Billings and
mounted petition drives.

As one of the few Montana doctors offering opioid therapy, Nelson was
"like the Mother Teresa of medicine," says Jeannie Huntley, a
marketing consultant who suffered brain and neck injuries from a car crash.

No one knows yet if any of Nelson's patients may have overdosed or
illegally sold their meds--and the DEA is keeping mum. But even if he
is eventually absolved, the Montana native plans to close his
practice. "We thought we were doing everything just about right," he
says. "But now a whole bunch of people are sitting out there hurting
like hell." --With reporting by Pat Dawson/Billings