ATTORNEYS GENERAL STEP INTO PAIN PRESCRIBING DEBATE

The group is asking the DEA not to impede "the legitimate practice of
medicine," but the agency says it is not a barrier to care.

A new voice has joined the chorus claiming that recent actions by the U.S.
Drug Enforcement Administration appear to impede the prescribing of
controlled substances to treat pain.

The National Assn. of Attorneys General, in a Jan. 19 letter, called on DEA
Administrator Karen P. Tandy to meet with representatives of the
organization to "find ways to prevent abuse and diversion without
infringing on the legitimate practice of medicine or exerting a chilling
effect on the willingness of physicians to treat patients who are in pain."

The letter was signed by the attorneys general from 29 states and the
District of Columbia. The effort was led by Oklahoma Attorney General and
NAAG Past President W.A. Drew Edmondson, who said he was approaching the
issue from a consumer-protection standpoint.

"If our consumers are not receiving what they need and want as health care
consumers, then that's a problem for the attorney general," Edmondson said.
"The new position of the DEA has at least the potential -- if not the
actual effect -- of being a barrier to doctors prescribing the proper drugs
for treating pain. I fully support efforts to combat diversion, but we have
to find ways to combat diversion that does not impact on good patient care."

Edmondson said it appears that investigating physicians might be the new
focus of DEA anti-diversion efforts, and he disagrees with that approach.
"We should concentrate on drugs that are illegally on the streets and work
backward from that to find out how they got illegally on the streets," he
said. "It should not be the other way around looking at doctors."

In August 2004, after working for more than two years with experts in the
field of pain medicine, the DEA released a frequently-asked-questions
document on prescribing controlled substances for pain treatment that
sought to balance physician concerns about effective treatment and law
enforcement issues regarding diversion of prescription drugs. The DEA
removed the document from its Web site in October 2004, and posted a notice
in the Nov. 16 Federal Register stating that the document contained
incorrect information. Some physicians said the new policy statement
appeared to criminalize more prescribing activity.

Most Americans say they would prefer to die at home, free of pain and
without unwanted medical intervention.

On Jan. 18, another notice was posted notifying the public that the agency
was in the process of preparing another document and was seeking comments
from physicians and other interested parties about what they wanted the
document to include.

The NAAG letter expressed surprise that the DEA "apparently shifted its
policy" from balancing medical and law enforcement concerns.

"We are concerned that state and federal policies are diverging with
respect to the relative emphasis on ensuring the availability of
prescription pain medications to those who need them," the letter stated.

DEA spokesman Rusty Payne denied there had been a shift in policy.

"DEA has not changed any policy related to this issue," Payne said in an
e-mail. "The reason for taking down the FAQs was simply because there was
some information that was incorrect. ... DEA has not changed its
enforcement emphasis with respect to investigating physicians involved in
the illegal prescribing of pharmaceutical narcotics."

He added that no meeting had been scheduled with the NAAG.

Most Americans die in a hospital or nursing home.

Attorney and pain medicine advocate Mary Baluss, the director of the Pain
Law Initiative in Washington, D.C., said she cheered when she first saw the
NAAG letter, but then her enthusiasm was dampened somewhat when she saw
that attorneys general for 21 states had not signed the letter.

Edmondson, however, was satisfied with the signatures the letter received.
"Getting all 50 to sign is pretty near impossible -- getting three
attorneys in a room to agree on something is problematic," he said.

Edmondson's interest in pain treatment stems from his work promoting better
end-of-life care.

He said that interest was sparked when he attended a bioethics program
where he learned that most Americans would prefer to die at home with
friends and family, free of pain and without unwanted medical intervention.
Instead, he said, most Americans die in pain at a hospital or nursing home.

"I was thinking, 'What's wrong with this picture and what can I do about
it?' " Edmonson said.

He formed an end-of-life care task force in Oklahoma and, while serving as
the 2002-03 NAAG president, selected end-of-life care as the subject of his
presidential initiative.

"There has been an increased focus, I believe, by medical licensing boards
on the undertreatment of pain and, with the shift by the DEA, doctors are
in a tough, tough position," Edmondson said. "Anything we can do to lessen
that squeeze, I believe, is helpful, and that's the purpose of the letter
to the DEA."

American Medical Association policy states that "physicians who
appropriately prescribe and/or administer controlled substances to relieve
intractable pain should not be subject to the burdens of excessive
regulatory scrutiny, inappropriate disciplinary action or criminal prosecution."