OXYCONTIN DEBATE

Thousands of people in Alabama depend on OxyContin and other
prescription pain-killers. The same drugs, however, are also popular
on the black market.

Trouble is, the government's actions to keep OxyContin out of illegal
channels are making it more and more difficult for 48 million
Americans who suffer from chronic pain to get relief.

From a doctor's viewpoint, Dr. Joel Hochman, director of the National
Foundation for the Treatment of Pain, says Washington is engaged "in a
fruitless and bizarre effort to curtail the abuse of drugs" that has
begun to negatively affect "its citizens and its physicians."

Of the 4,383 pain management doctors listed on the DoctorsForPain.com
registry, 90 are located in Alabama. That averages out to about one
chronic-pain doctor per county, meaning the loss of a single physician
can cut off hundreds of Alabamians from access to pain care.

To the Drug Enforcement Administration, this fragile network of care
givers is a tempting law-enforcement target.

In the 1990s, the DEA began targeting doctors who treat patients with
high doses of OxyContin. To the DEA, these doctors look like potential
drug traffickers and a pipeline to the black market.

Pain doctors' approach to OxyContin is to prescribe increasingly high
doses until a patient's pain abates or side effects set in. Because
this treatment is still controversial among some physicians, pain
practitioners are vulnerable at trial.

In 1993, to bankroll the DEA's war on doctors, Con gress set up a
diversion control fund. Each year, a million doctors buy a license to
prescribe FDA-approved drugs. In 2003, this fee was doubled. The DEA
now rakes in about $130 million per year from these fees -- money that
is used to hire investigators to target physicians.

The agency also gets funding each year -- $54 million in 2002 -- from
an asset forfeiture fund, including assets that once belonged to
physicians prosecuted by the DEA. These two pots of money afford the
agency the financial incentives and the freedom from congressional
oversight to vigorously prosecute pain doctors.

The DEA monitors the prescription writing habits of all doctors, and
those prescribing high doses of OxyContin raise a red flag.
Investigators go to work: Plea bargains win testimony from former
patients. Indictments are filed.

Trial juries hear from DEA-hired doctors who say that the use of high
levels of OxyContin are outside the normal practice of medicine.
Doctors for the defense give contrary testimony.

Faced with conflicting expert testimony, lay juries tend to convict.

In the past three years, according to Hochman, the DEA investigated
about 1,800 doctors nationwide -- 1,200 of whom lost their
prescription license.

"When doctors are investigated by the DEA," Hochman said, "their usual
response is to cease treating pain patients." Assuming each doctor
serves 300 patients, as many as 180,000 pain patients lose their care
providers each year, according to him.

Each publicized DEA investigation and conviction spreads fear. Other
doctors may voluntarily get out of, or decide not to go into, the
practice of pain management.

To catch the few bad doctors, the DEA is driving many more good ones
out of business.

Some patients who lose their support systems turn to the black market
or even suicide for relief.

Dr. Jane Orient of the Association of American Physicians and
Surgeons, believes that the DEA uses "dirty tricks" to convict doctors.

"Physicians are being threatened, impoverished, de-licensed and
imprisoned for prescribing in good faith with the intention of
relieving pain," Orient said. "Law enforcement agents are using
deceitful tactics to snare doctors, and prosecutors manipulate the
legal system to frighten doctors who might be willing to testify on
behalf of the wrongly accused doctors."

In March 2004, DEA administrator Karen Tandy told Congress that her
drug warriors have "been successful in addressing OxyContin diversion,
as evidenced by a reduction in the rate of increase of OxyContin
prescriptions being written and a leveling-off of OxyContin sales."

But this cockeyed measure of success makes no sense. Respected experts
estimate the pain experienced by 40 percent of cancer, AIDS and
terminally ill patients already goes under-treated.

Thanks to DEA, Orient predicts, "If you have an operation or an acute
injury, chances are your doctor will order adequate pain medication.
But if you are one of the millions with chronic, intractable,
so-called 'benign pain,' you may be told to learn to live with it."

Bottom line? The loss of one Alabama pain physician will not create a
ripple in the black market. But 300 honest citizens in pain may curse
the DEA's tactics when they are told, "Learn to live with it."