PAIN RELIEVER OR DRUG DEALER?

Physician Who Eases Patients' Agony Treated Like A Drug Kingpin

Federal prosecutors in Virginia want Dr. William Hurwitz, recently
convicted on 50 counts of distributing narcotics, to go to prison for life
without parole when he is sentenced in mid-April.

For the 50 million or so Americans who suffer from chronic pain, the fate
of Hurwitz should be of some interest. He is a prominent doctor committed
to aggressive treatment of pain. His behavior in some cases was
inexcusable. Patients for whom he freely provided large prescriptions
should, at the very minimum, have been given more close supervision. But
malpractice should be cause for loss of license.

Instead, Hurwitz has been prosecuted as a drug kingpin because some
patients sold their pills, although prosecutors never claimed he made a
penny from it. That sends a chilling message to doctors who treat people
with extreme pain.

Hurwitz's case involved prescriptions for opioids like OxyContin or
Vicodin. Abuse of those drugs can be a lethal problem, but the new
consensus among pain doctors is that very high doses are appropriate in
some chronic pain cases. The Drug Enforcement Administration apparently
disagrees. The Hurwitz case shows that increasingly it is the DEA, not
doctors, that decides what is appropriate therapy.

Last August, the DEA published policies to guide doctors in treating pain.
The document said the amount or duration of pain medicine prescribed was a
physician's decision and would not by itself spark a criminal
investigation. Hurwitz's lawyers filed to introduce it as evidence.
Mysteriously, it suddenly disappeared from the DEA Web site. The agency
then announced it contained "misstatements." In November, the agency
published new guidelines that said doctors who prescribe high dosages of
opioids for long stretches are subject to investigation.

Pain is already undertreated in America. Although pain experts estimate
that perhaps one in 10 people who suffer from chronic pain could benefit
from opioids, the vast majority will never find this out. Many doctors
won't prescribe opioids, especially in high doses. Opioids are safe and
nonaddictive if used correctly, but addictive and deadly if crushed and
injected or snorted.

Abuse of narcotics like OxyContin is a serious problem and has devastated
many communities. But a huge amount of OxyContin on the street is stolen
from pharmacies -- 1.5 million tablets from 2001 to 2003, according to the
D.E.A. Diversion of prescriptions may account for only a small part of the
abuse, but it has brought a sadly disproportionate response from
authorities. For example, Richard Paey, who has used a wheelchair since a
car accident in 1985 and also developed multiple sclerosis, is serving a
25-year prison sentence in Florida for fraudulently obtaining prescriptions
for Percocet even though prosecutors acknowledged he consumed all the pills
himself.

Dozens of doctors have been charged with drug trafficking because the DEA
felt they were prescribing too many pills. The Association of American
Physicians and Surgeons warns doctors to think twice before treating pain:
"Discuss the risks with your family."

One California doctor who prescribed opioids, Frank Fisher, was charged
with five counts of murder, including that of a patient who died as a
passenger in a car accident. All charges were dropped. A doctor in Florida,
James Graves, is serving 63 years for four counts of manslaughter involving
overdoses by people who either abused their prescriptions or mixed their
prescribed medicines with other drugs.

Hurwitz, a crusader for aggressive pain treatment, had a controversial
practice. More than 90 percent of his patients were genuine, and many say
he was the only doctor who quieted their chronic pain. But his willingness
to treat patients other doctors shunned, including drug addicts, also
attracted scammers. It is legal to prescribe to addicts who are in pain,
and many respected pain doctors believe that in some cases, addiction is
caused by untreated pain and ends when the pain is controlled.

Hurwitz, who was disciplined by medical boards several times, testified
that he did dismiss 17 patients he concluded were abusing their
prescriptions and was tapering down the dosage of others. But he also said
he felt cutting off patients was tantamount to torture and did not do so
without strong evidence of bad behavior.

Many of Hurwitz's colleagues believe that he was far too slow to accept
such evidence and that he should not have been practicing medicine. But
while he was blind to his patients' deceptions, there has never been any
evidence that he was part of their conspiracy. In the prosecutors'
post-trial motions, they argue that the conviction should stand even if
Hurwitz believed he was prescribing for a legitimate medical purpose.

His prosecution seems inexplicable except as a signal to other doctors that
they can go to prison for life for being duped by their patients. That
signal is being heard; the exodus from aggressive treatment of pain is
increasing. This might marginally reduce the amount of opioids on the
street, but in the process it will sentence hundreds of thousands of people
to suffer needlessly. Tina Rosenberg writes for The New York Times, 229 W.
43rd St., Room 943, New York, NY 10036.