U.S. REP. RON PAUL'S COMMENTS ON THE PERSECUTION OF PAIN DOCTORS

Comments Made Before the U.S. House of Representatives Feb. 12,
2004

Mr. Speaker, the publicity surrounding popular radio talk show host
Rush Limbaugh's legal troubles relating to his use of the pain killer
OxyContin hopefully will focus public attention on how the federal
drug war threatens the effective treatment of chronic pain.
Prosecutors have seized Mr. Limbaugh's medical records to investigate
whether he violated federal drug laws. The fact that Mr. Limbaugh is a
high profile, controversial, conservative media personality has given
rise to speculation that the prosecution is politically motivated.
Adding to this suspicion is the fact that individual pain patients are
rarely prosecuted in this type of case.

In cases where patients are not high profile celebrities like Mr.
Limbaugh, it is pain management physicians who bear the brunt of
overzealous prosecutors. Faced with the failure of the war on drugs
to eliminate drug cartels and kingpins, prosecutors and police have
turned their attention to pain management doctors, using federal
statutes designed for the prosecution of drug dealers to prosecute
physicians for prescribing pain medicine.

Many of the cases brought against physicians are rooted in the federal
Drug Enforcement Administration's failure to consider current medical
standards regarding the use of opioids, including OxyContin, in
formulating policy. Opioids are the pharmaceuticals considered most
effective in relieving chronic pain. Federal law classifies most
opioids as Schedule II drugs, the same classification given to cocaine
and heroin, despite a growing body of opinion among the medical
community that opioids should not be classified with these substances.

Unfortunately, patients often must consume very large amounts of
opioids to obtain long-term relief. Some prescriptions may be for
hundreds of pills and last only a month. A prescription this large may
appear suspicious. But according to many pain management specialists,
it is medically necessary in many cases to prescribe a large number of
pills to effectively treat chronic pain. However, zealous prosecutors
show no interest in learning the basic facts of pain management.

This harassment by law enforcement has forced some doctors to close
their practices, while others have stopped prescribing opioids
altogether - even though opioids are the only way some of their
patients can obtain pain relief. The current attitude toward pain
physicians is exemplified by Assistant U.S. Attorney Gene Rossi's
statement that "Our office will try our best to root out [certain
doctors] like the Taliban."

Prosecutors show no concern for how their actions will affect patients
who need large amounts of opioids to control their chronic pain. For
example, the prosecutor in the case of Dr. Cecil Knox of Roanoke,
Virginia, told all of Dr. Knox's patients to seek help in federal
clinics even though none of the federal clinics would prescribe
effective pain medicine!

Doctors are even being punished for the misdeeds of their patients.
For example, Dr. James Graves was sentenced to more than 60 years for
manslaughter because several of his patients overdosed on various
combinations of pain medications and other drugs, including illegal
street drugs. As a physician with over thirty years of experience in
private practice, I find it outrageous that a physician would be held
criminally liable for a patient's misuse of medicine.

The American Association of Physicians and Surgeons (AAPS), one of the
nation's leading defenders of medical freedom, recently advised
doctors to avoid prescribing opioids because, according to AAPS, "drug
agents set medical standards." I would hope my colleagues would agree
that doctors, not federal agents, should determine medical standards.

By waging this war on pain physicians, the government is condemning
patients to either live with excruciating chronic pain or seek opioids
from other, less reliable, sources - such as street drug dealers. Of
course opioids bought on the street likely will pose a greater risk of
damaging a patient's health than opioids obtained from a physician.

Finally, as the Limbaugh case reveals, the prosecution of pain
management physicians destroys the medical privacy of all chronic pain
patients. Under the guise of prosecuting the drug war, law
enforcement officials can rummage through patients' personal medical
records and, as may be the case with Mr. Limbaugh, use information
uncovered to settle personal or political scores. I am pleased that
AAPS, along with the American Civil Liberties Union, has joined the
effort to protect Mr. Limbaugh's medical records.

Mr. Speaker, Congress should take action to rein in overzealous
prosecutors and law enforcement officials, and stop the harassment of
legitimate physicians who act in good faith when prescribing opioids
for relief from chronic pain. Doctors should not be prosecuted for
using their best medical judgment to act in their patients' best
interests. Doctors also should not be prosecuted for the misdeeds of
their patients.

Finally, I wish to express my hope that Mr. Limbaugh's case will
encourage his many fans and listeners to consider how their support
for the federal war on drugs is inconsistent with their support of
individual liberty and constitutional government.