PAINKILLER GUIDELINES DESIGNED TO AID DOCTORS

DEA tries to satisfy pain specialists

WASHINGTON - The federal Drug Enforcement Administration and top pain
specialists Wednesday jointly issued detailed guidelines designed to
reassure worried doctors that they will not be prosecuted for prescribing
high doses of powerful, morphine-based painkillers for patients who need
them for intractable pain.

The guidelines also make it more clear, however, that doctors have
responsibilities to ensure that their pain patients are not abusing
prescription opioids like OxyContin and are not doctor-shopping to collect
narcotics for illicit sales.

The new document, which will be distributed to law enforcement agencies and
all doctors who apply for DEA approval to prescribe controlled drugs, is an
effort to resolve a controversy that has bedeviled pain specialists.

An earlier consensus paper failed to clarify the issues, leading to a
situation in which many patients with severe pain have been turned away by
doctors and pharmacists concerned that prescribing and dispensing opioid
painkillers would get them in trouble with the law.

"We hope this is a step in the right direction, to reverse an increasingly
unfriendly environment for pain management," said one of the authors of the
new guidelines, University of Wisconsin pain studies director David
Joranson.

Getting the agency to publicly describe its position on prescribing opioids
"will make more clear that the DEA understands good medicine and would be
avoiding it in their investigations," he said. "A lot of people don't feel
now that's the case."

The new guidelines spell out steps that assure proper prescribing, such as
how to diagnose severe pain and keep proper records to justify prescribing a
narcotic painkiller.

Written largely in a question-and-answer form, the document makes clear to
law enforcement that even heavy use of prescription opioids can be
appropriate and that the physical dependence it brings is not the same thing
as physical addiction.

The DEA and other law enforcement agencies stepped up their prosecutions of
doctors, pharmacists and some of their employees after the prescription
narcotic OxyContin became widely used and abused in the late 1990s,
resulting in numerous overdoses.

With hundreds of doctors charged in recent years, pain patients and doctors
who treat them have complained of a growing climate of fear - adding to what
is widely seen as a serious nationwide problem of inadequate pain treatment.