Pain, Pills & Persecution

DOCTORS: PATIENT CARE LOSING TO WAR ON DRUGS

First of a two-part series

Pain is not, for Paul, distant or abstract. Not pastels, but ragged reds and
bottomless blacks. Not a whisper, but a stabbing shriek, the smell of
scorching. His pain is centered, overwhelming. It twists tissue in a coiled
death-grip, felling him.

When, as now, he is without medication to soften the pain, you can look into
Paul's eyes and see it. His posture, his words, reveal it. Paul, at this
instant, is pain and little else. Pain controls thought and emotion, poise
and posture.

With law enforcement increasingly second-guessing medical judgments on the
need for narcotics, doctors are reluctant to help.

Doctors cannot eliminate Paul's pain because, in addition to being born with
spina bifida, he has degenerative disc disease and facet disease. Only 50
years old, he will never again be free of pain.

Doctors could limit his suffering.

They will not.

Paul is new to Alabama and distant from the doctor who, after numerous
tests, determined the only help for Paul was to alleviate his pain with
opioids. Paul does not know why doctors will not help, and many share his
confusion if not his desperation.

Almost any doctor in the state could prescribe the one class of chemicals
that would ease Paul's pain, but many are afraid to do so.

Paul asked that his last name not be used for fear it would make even less
successful his thus-far futile search for a doctor willing to prescribe
painkillers.

Opioids are Schedule II drugs. Opioids, related to the chemical found in the
sap of the opium poppy, include OxyContin, Viodin, Lorcet and most other
effective painkillers.

With every opioid prescription, doctors take a risk. With drug enforcement
agents targeting them, they risk not just the loss of the patient and his
fees. They risk their reputation, their career and even their freedom.

Because of the "War on Drugs," doctors who treat chronic pain with its only
effective countermeasure risk prison. The result is an increasing number of
medical practices displaying signs that say "No OxyContin prescribed here."

Medication Praised

Some who have been more successful than Paul at obtaining opioids praise the
medication.

Theresa, a Morgan County resident who asked that her last name not be used,
said she has been taking OxyContin for almost a year because of an
inoperable back condition.

"I don't understand why it is so controversial. For me, it is like other
pain medicines except it lasts longer," Theresa said.

She said narcotics other than time-release OxyContin tend to wear off at
night, interrupting her sleep.

Theresa said she used to have several days a month when she had to call in
sick for work. Since starting OxyContin, her back pain has not caused her to
miss work once, she said.

Christie, 30, a Blount County resident who asked that her last name not be
used, said aggressive prosecution of doctors prescribing opioids is in part
a result of confusion. Short-term or erratic ingestion of opioids causes a
high, she said, but after about three weeks of consistent use, the high
disappears. After those first weeks, the only benefit to opioids is pain
relief, Christie said.

Stigma of Use

Long after the high subsides, however, the stigma continues.

"Doctors and nurses look at you different if they know the medications you
are on. They flag your file and view you as an addict," said Christie, the
mother of three children.

She said she believes much of the stigma results from health providers' fear
of U.S. Drug Enforcement Agency prosecutions, a factor she thinks should not
be a part of the health-care equation. Christie has a herniated disc in her
back and, because of unsuccessful surgeries, has a spinal fluid leak.

Christie said she would be unable to care for her children without pain
medication. Even with the medication, she has been unable to pick up her
child since March 2000. She has been on opioids since November 2000.

Paul also resents the stigma.

"Do you know how it feels to have a doctor tell you that you shouldn't hurt
so much? It's like I am some kind of second-class weak person. If they were
unlucky enough to be feeling my pain, they would be begging for help," he
said.

Island of Pain

Law enforcement officials likely do not want to imprison well-intentioned
doctors. And most doctors do not want to prescribe drugs that will be abused
on the street. But the conflict between the two groups has left many, like
Paul, marooned on an island of pain with only suicide or street drugs
permitting escape.

DEA and local law enforcement officials say their crackdown on Schedule II
drugs like OxyContin is necessary because the medication has become a
popular and sometimes deadly recreational drug.

Most fatalities occur when a user defeats the time-release feature of the
drug by either chewing it or turning it into a powder that can be injected
or snorted.

Heart failure has killed many who experienced the heroin-like rush of a
12-hour dose entering the system all at once.

Siobahn Reynolds collided with the chilling effect of aggressive enforcement
in a personal way. She is convinced that Virginia doctor William Hurwitz,
last month charged with drug trafficking resulting in death and serious
injury, engaging in a criminal enterprise, conspiracy and health-care fraud,
saved her husband's life.

Reynolds said her husband, Sean, had a serious medical condition, but he was
near death because the pain from the condition left him bedridden. The
inactivity compromised his breathing.

"He was dying of a breathing disorder, caused from all the time in bed. Dr.
Hurwitz was willing to get involved, give him the meds he needed. And
Hurwitz thus risked everything to save Sean. He is a rarely ethical doctor,
something the DEA cannot imagine," Reynolds said.

Reynolds was so infuriated by the difficulty her husband had in obtaining
pain medication, and at the risk doctors took in providing it, that she
formed the Pain Relief Network, a grassroots organization designed to help
prosecuted doctors and influence drug policy.

Doctors argue the prosecution of opioid prescribers is a witch-hunt that has
forced good doctors to refrain from prescribing good medicine to hurting
patients.

Dr. Fred Fisher, a pain-management doctor who successfully defended himself
against a DEA action in California, said the crackdown on opioids not only
deprives needy patients of their one shot at a normal life, it also makes
little sense if the goal is to protect the public. Unlike many abused
substances, Fisher said, opioids are non-toxic.

"Opioids almost never hurt patients who take them as prescribed. They are
dangerous only to abusers, who mix them with sedatives and alcohol," Fisher
said.

Maybe the chilling effect of DEA enforcement efforts have prevented a few
overdoses, Fisher acknowledges.

But at what cost in pain-related deaths and human misery?