SPECIALISTS DECRY DEA REVERSAL ON PAIN DRUGS

New Rules Called A 'Step Backward'

Three medical associations representing pain specialists have sent the Drug
Enforcement Administration an unusual joint letter sharply critical of its
recently revised guidelines on prescribing pain medicines. The letter,
signed by the presidents of all three groups, called a DEA policy statement
published in November in the Federal Register "an unfortunate step
backward" that encourages a return to "an adversarial relationship between
[doctors] and the DEA."

Already concerned about what they saw as sometimes over-aggressive
prosecutions of doctors, pharmacists and other health professionals who
prescribe narcotic painkillers such as OxyContin, the specialists said the
new DEA position threatens their ability to provide care to millions of
patients. The presidents wrote that despite the DEA's assurances that it
does not want to discourage doctors from providing proper narcotic
medication to people in pain, the new guidelines "will undoubtedly have the
exact opposite effect on any practitioner reading them."

DEA spokesman Bill Grant said in response that the agency "wishes to
reassure the public that the withdrawal of the August [statement] does not
represent any change in DEA's investigative emphasis or approach.
Physicians acting in good faith and in accordance with established medical
norms should remain confident that they may continue to dispense
appropriate pain medications."

He said the DEA is working on a process to gather the views of the medical
community as it refines its policy.

The letter from the heads of the American Pain Society (APS), the American
Academy of Pain Medicine (AAPM) and the American Society of Addiction
Medicine (ASAM) is a response to a Nov. 16 DEA statement that repudiated
some parts of a jointly negotiated set of guidelines that had been
introduced with fanfare in August.

The August guidelines -- in the form of answers to 29 frequently asked
questions -- were the result of two years of discussion and negotiation
between pain specialists and the DEA. They were embraced by many doctors as
a breakthrough in resolving a deepening conflict between law enforcement
and pain management practitioners.

The August guidelines were posted on the DEA Web site and given an
enthusiastic review in the Journal of the American Medical Association. But
less than two months later, the agency took the document down and replaced
it with a notice saying some of the earlier statement was inaccurate and
did not represent a DEA policy statement.

The pain specialists' letter took particular aim at the agency's new
description of prescribing practices that can lead to a DEA investigation.
The DEA said doctors who prescribe high dosages of opioid painkillers to
patients for long periods of time are subject to investigation. It also
said the government can open investigations on the suspicion that a doctor
is diverting controlled drugs or to make sure there is no improper
activity. In reply, the three pain groups wrote: "Reading that the
government can investigate merely on suspicion that the law is being
violated will send chills down the spine of practitioners who are treating
patients with [narcotic painkillers] and will certainly contribute to the
undertreatment or non-treatment of moderate to severe chronic pain." The
letter was signed by APS President Dennis C. Turk, AAPM President Samuel J.
Hassenbusch and ASAM President Lawrence Brown.

Separately, five past presidents of the American Pain Society wrote a joint
letter criticizing the courtroom testimony of Michael Ashburn, who was the
government's expert witness in the recent high-profile trial of William E.
Hurwitz, a prominent McLean pain doctor. The letter, sent to Hurwitz's
attorney, accused Ashburn, who is also a past president of the group, of
making factual errors in describing appropriate prescribing. "We are
stunned by his testimony," the letter said. "As leaders in this field, we
feel compelled to correct the errors in his testimony, lest it be used in
the future in a manner that worsens the national tragedy of untreated pain."

Hurwitz was convicted in U.S. District Court in Alexandria last week of 50
counts of drug trafficking for his prescribing of opioids to patients.