LAW'S INTRUDING ON MEDICINE DOES LITTLE FOR PATIENTS

In early 1999, state officials spun a tale involving a drug-abusing
physician whose greed and contempt for the law led him to run a pill mill
that created thousands of addicts and left a trail of dead bodies. They
charged him with multiple counts of murder and set his bail at $15 million.

Five years later, a jury acquitted the doctor of even misdemeanor fraud
charges. As for the deaths, the original murder charges were reduced to
involuntary manslaughter, delayed for years, then dismissed in 2003. State
prosecutors say medicine has evolved and the practices that made Dr. Frank
Fisher a menace to society then would not be worth bringing before a jury
today.

The utter collapse of the state's case against Fisher and Stephen and
Madeline Miller, former owners of the Shasta Pharmacy, shows the hazards of
trying to answer medical questions in the criminal courts.

OxyContin -- the opiate painkiller at the heart of the case -- is both
highly effective and powerfully addictive. It has given patients relief
from chronic crippling pain but also spawned crime waves fed in part by
patients who resell their prescription pills. Where is the divide between
aggressive pain treatment and reckless dispensing of addictive drugs?

To the state, it originally seemed obvious that Fisher and the Millers were
far over the line. In 1998, Fisher prescribed and Shasta Pharmacy dispensed
huge quantities of oxycodone, the generic name for OxyContin. Shasta
Pharmacy was by far the state's largest retail distributor of the drug,
largely because of Fisher's prescriptions. And, of course, people had died.

But OxyContin had come on the market in 1996, and its use was quickly
spreading. Today its manufacturer, Purdue Pharma, sells about $1.2 billion
worth a year. Fisher may simply have been ahead of the curve in his
practice, which should not be a crime.

It would be too easy to say that the police should never intrude on the
doctor-patient relationship. Physicians are not saints. Criminals abuse the
system. Vast sums of taxpayer money are spent on Medicare and Medi-Cal, and
the government must pursue suspected fraud.

Still, there are clear signs of a system out of balance. The Association of
American Physicians and Surgeons recommends that doctors avoid using
opiates in pain management because the risk of prosecution is too steep.

That fear is entirely justified. Doctors around the country are serving
long prison terms after being prosecuted on charges related to
overprescribing painkillers. Fisher and the Millers have lost their homes,
livelihoods and reputations, but having their freedom leaves them better
off than some.

Prosecution of suspected wrongdoers is not a problem -- it is law
enforcement's job -- but a climate of paranoia that prevents legitimate
pain patients from receiving treatment only causes needless suffering. The
system must guard against abuse, but our medical standards should be set by
doctors and patients, not cops and robbers.