HIGH-DOSAGE OPIOIDS SAVED HIS LIFE, PATIENT SAYS

Jay Steffler spent more than eight years in pain and in bed after a
hospital accident that left him with a rare ailment called reflex
sympathetic dystrophy. With many of his nerve endings constantly firing,
Steffler, a Pittsburgh piano player and documentary maker, tried treatments
from spinal blocks to acupuncture, from anti-epileptic drugs to hypnosis.
Nothing helped for more than a short time, he said, and he was in
near-constant pain.

In 1999, Steffler took what he considered to be the desperate step of
contacting McLean pain doctor William E. Hurwitz, who had a controversial
national reputation for his use of high-dosage opioids to treat and control
pain. Steffler, now 44, said he had been given only small doses of opioids
before seeing Hurwitz because his doctors were concerned about addiction
and about drawing unwanted regulatory attention to themselves.

Hurwitz put him on a number of prescription opioids and adjusted the
dosages repeatedly for two weeks to see what worked best. Steffler said the
change was immediate and lasting.

"For the first time in years, I didn't have pain," he said. "I started to
walk again, and I felt like I got my life back. . . . It was like I came
out of a coma."

Steffler said the opioids, including OxyContin and Dilaudid, did not make
him feel euphoric or high, but as close to normal as he can hope to be. He
has started to work again as a piano teacher.

Because of his success with Hurwitz, Steffler was confused and dismayed
when his doctor came under investigation by federal authorities, and then
in September was indicted for drug trafficking and running his medical
practice as a criminal enterprise. Federal prosecutors have accused him of
distributing drugs that ended up on the black market, and prescribing
practices that led to the deaths of three patients and fueled the abuse of
painkillers.

But Steffler sees things differently. "Without Dr. Hurwitz, I'd probably be
dead by now," he said.

After Hurwitz lost his Drug Enforcement Administration license to prescribe
opioids, Steffler said it took a long time to find another doctor who would
prescribe the kind of drugs that were clearly helping him. And once he did
locate a doctor, he found that his insurance company no longer would pay
for the narcotics. With the help of a disabilities law attorney he got the
company to pay, but he says he still has constant problems getting his
medications.

"They treat me like I'm a criminal or something," he said. "I only get a
one-week supply at a time, and sometimes I have to wait for hours at the
pharmacy. And the pharmacist who fills my prescriptions is the only one in
town who will do it, so if he goes, then I'm finished."