REMOVAL OF FAQS ABOUT PRESCRIPTIONS ON DEA WEB SITE CAUSES TURMOIL

The Agency's "Clarification" Appears to Criminalize a Practice Now
Taught in Pain Medicine Programs.

What was once considered a feel-good document co-authored by U.S. Drug
Enforcement Administration staff and pain medicine experts is now
causing ill will, confusion and concern that relations between the
agency and the medical community have taken a turn for the worse.

The DEA wrote in the Nov. 16 Federal Register that a "frequently asked
questions" document it co-authored with the University of Wisconsin
Pain & Policy Studies Group and the Last Acts Partnership contained
"misstatements." These included remarks on what could trigger an
investigation and the appropriateness of writing multiple
prescriptions on the same date. These items in particular have caused
concern in the pain medicine community because they appear to reverse
policies endorsed in the original document, which was taken off the
DEA Web site in October.

The DEA's Nov. 16 interim policy statement said documents must be
published in the Federal Register to obtain status as an official
policy or statement, and the FAQ document never was. It also stated
that a more complete statement responding to agency concerns about the
FAQ would be published in the future.

The published announcement included a promise to take "into
consideration the views of the medical community." But in the
meantime, those involved in the creation of the FAQ say they have had
no contact with DEA officials. In contrast, Pain & Policy Studies
Group Director David Joranson said there was frequent consultation
over the 20 different drafts of the original FAQ document.

Russell K. Portenoy, MD, who served as the leading expert on pain
medicine for the panel that wrote the FAQ document, said the interim
policy statement appears to criminalize practices such as allowing
doctors to write smaller, multiple prescriptions with different dates
for dispensing.

Dr. Portenoy, chair of the Dept. of Pain Medicine and Palliative Care
at New York City's Beth Israel Medical Center and a faculty member for
the AMA online pain management program, said this allowed better
medication management and helped prevent gaps in treatment that could
lead to pain or withdrawal -- especially for patients who rely on
mail-order pharmacies. In addition, he said, it's a practice that is
now regularly taught in physician pain programs.

Dr. Portenoy said he also was concerned about statements in the
Federal Register notice about what physician behavior could trigger
law enforcement scrutiny.

The DEA did not respond to questions, which it required be sent via
e-mail, but its Federal Register posting noted that it can start an
investigation if it suspects laws are being broken or if it wants
assurances that they aren't.

The AMA had no comment on the DEA action, but its policy supports the
position 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."