WAR AGAINST LEGAL DRUGS

The very same federal Drug Enforcement Agency that has repeatedly failed to
slow the flow of illegal cocaine from abroad is now waging -- with help
from its state partners -- an alarmingly successful war against legal
prescription drugs here at home.

Problem is, the tactics used to keep these drugs off the black market have
a nasty side-effect: Many terrified hometown physicians no longer give 15
million Americans struggling with chronic pain the medicines they need.

In 2002, according to Dr. Joel Hochman, director of the National Foundation
for the Treatment of Pain, the DEA investigated 622 physicians and brought
charges against 586. In 426 cases, medical licenses were revoked "for cause."

"If the DEA continues as at present, there won't be any doctors writing
opioid prescriptions in two more years," Hochman said. (Opioids, like
OxyContin, are highly effective painkillers made from either opium or
synthetics with the properties of opiate narcotics.)

Some observers say that the Alabama Board of Medical Examiners' 2001
decision to revoke the medical license of Dr. Pascual Herrera Jr. of
Gadsden, after three of his patients died of OxyContin overdoses, reflects
a "drug war mentality" that too quickly blames doctors for the actions of
their patients.

State and federal agents justify their actions as a response to DEA reports
that "Alabama continues to see an increase in diverted pharmaceuticals
across the state, and OxyContin is still the No. 1 abused drug." In 2000,
Alabama was ranked 11th nationally for the number of OxyContin
prescriptions written per capita.

It is true that some pain patients do sell their pills on the black market.
Others overdose by mixing prescription medicines with other drugs and die.
And perhaps some physicians knowingly take part in these illegal schemes.

But most doctors under attack, claims Hochman, are not deliberately abusing
their professional responsibilities. They simply need better pain control
training and office management skills.

His solution is for DEA, state regulatory agencies and state medical boards
to work with -- rather than against -- the nation's 5,000 doctors
practicing chronic opioid therapy.

"To be a competent physician," says Hochman, "every doctor in the United
States needs to be adequately trained -- and most are not -- in the
management of intractable pain. Law enforcement and physicians must work
together to separate the sheep from the wolves and to identify and
prosecute the small number of prescription abusers.

"Targeting the physician only drives legitimate pain patients into deeper
despair, terminal hopelessness and into the black market for relief -- as
in the case of Rush Limbaugh."

This heavy-handed approach is a three-part recipe for disaster:

- --Abandoned patients.

A pain practice might have 200 to 500 patients. As doctors lose their
licenses, the number of abandoned patients will go up and all pain
sufferers will have a harder time finding the care they need.

Where will abandoned pain patients find relief when other doctors in town
are "narcophobic"? Many will turn to illegal channels, meaning these law
enforcement tactics will actually create new customers for the same black
market in drugs they claim to be dismantling.

- --Fearful doctors.

To avoid trouble, fewer physicians are likely to start new pain care practices.

Signs already appearing in doctors' offices read "Do not ask me to refill
pain medications" and "Don't ask for opioids," as doctors adopt a
cover-my-rear medical ethic that ignores their patients' welfare.

Even nursing home care is being harmed. Until outside pain consultants step
in, terminally ill nursing home patients may not get the pain control
medicines they need.

Staff physicians will be too afraid of the "drug warriors" to do their jobs.

- --Government intrusion.

Despite surveys that show seven of 10 Americans want their doctors, not the
government, to decide what medical treatment they will receive, aggressive
state and federal law enforcement tactics are bullying the medical
community to under treat Americans with severe pain.

Here is how Dr. Jane Orient, director of the Association of American
Physicians and Surgeons, sums up the situation: "Throughout the U.S.
physicians are being threatened, impoverished, delicensed and imprisoned
for prescribing in good faith with the intention of relieving pain. Law
enforcement agents are using deceitful tactics to snare doctors, and
prosecutors manipulate the legal system to frighten doctors who might be
willing to testify on behalf of the wrongly accused doctors."

This year, federal taxpayers, including folks living in Alabama, will give
DEA about $120 million to target doctors who aggressively use legal drugs
to ease pain.

I wonder if these taxpayers, especially those suffering from chronic pain
themselves, think this is money well spent.

Ronald Fraser, Ph.D., writes on public policy issues for the DKT Liberty
Project, a Washington-based civil liberties organization.