PAIN SPECIALISTS FEAR CHILLING EFFECT AFTER ARREST

The Action Came Within Weeks Of An FDA Panel's Ruling Against New Limits On
OxyContin Prescribing

Pain management physicians celebrated a victory recently when a federal
advisory panel ruled against a proposal to place more restrictions on how
they treat patients.

But their celebration was short-lived when an outspoken member of their
specialty was arrested on drug trafficking charges weeks later.

With this article Links See related content The good news came Sept. 10
when a U.S. Food and Drug Administration advisory panel voted 13-5 against
new restrictions on OxyContin prescribing that were suggested by the U.S.
Drug Enforcement Administration and members of Congress.

Two weeks later, pain management specialist William E. Hurwitz, MD, of
McClean, Va., was arrested and indicted on 49 counts of drug trafficking in
39 states. Authorities also linked him to the deaths of three patients.

"I was very heartened by the action of the FDA advisory panel," said Joel
Hochman, MD, a Houston psychiatrist and executive director of the National
Foundation for the Treatment of Pain. "There is no rational basis for
restricting the availability of OxyContin for pain patients or their
prescribing physicians."

While the decision against further restrictions made sense to him, he said
the arrest of Dr. Hurwitz outraged him and could lead to self-imposed
restrictions.

"You talk about a chilling effect," Dr. Hochman said. "I waited all last
night for them to kick my door down."

At the FDA hearing, Terrance Woodworth, deputy director of the DEA office
of diversion control, said more limits are needed on OxyContin promotion
and distribution, and that prescriptions should be limited to patients with
certain disease states or only given to those with severe pain.

An agreement on educating He also called for more efforts to educate
physicians, pharmacists and patients on the proper use and adverse effects
of opioids, and more "postmarketing surveillance" to monitor diversion and
adverse events.

Dr. Hochman said his group is also calling for more education efforts and
the creation of an electronic prescribing database for physicians. That,
however, is about where any agreement ends, as Dr. Hochman charges that
"billions are being wasted" by prosecuting and imprisoning patients with
addictions.

"When we give up the infantile need to demonize and punish, we will get
somewhere with the problem of substance abuse," he said.

L. Jean Dunegan, MD, an attorney and pain specialist at the Hillsdale Pain
Center in Hillsdale, Mich., said law enforcement officials are misdirecting
their efforts. She said physicians treating pain need to ask patients what
their goals are -- such as missing less work or participating more in
family activities -- and then create a carefully charted, multimodal plan
to reach that goal.

"It should be the plan they look at, not how many prescriptions we write,
not how many patients we have in our waiting rooms, and not how many cars
we have in our parking lot," Dr. Dunegan said.

The arrest of Dr. Hurwitz, which included parading him in jailhouse
stripes, was "government by P.R.," said Siobhan Reynolds, executive
director of the New York City-based Pain Relief Network. "I'm a theater
director in New York, so I can see where this is coming from."

Reynolds is not an unbiased observer. Her husband, who has Ehlers-Danlos
syndrome, was a patient of Dr. Hurwitz. She became an activist for pain
management when she learned that hospice patients were allowed to get the
pain relief they need but pain patients were not. "Why do you have to die
to get help?" Reynolds asked.

She said that before seeing Dr. Hurwitz, her husband had been bedridden for
seven years, became obese and developed respiratory disorders. "We're going
to do everything we can for Dr. Hurwitz," she said. "He saved my husband's
life and made it possible for him to get out of bed and lose weight."

Ed Childress, a spokesman for the DEA, disagreed with positive assessments
of Dr. Hurwitz. He said anyone who can be linked in an indictment to the
deaths of three people "would certainly not qualify as a hero in my
estimation."

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ADDITIONAL INFORMATION: Weblink Transcript of Food and Drug Administration
Anesthetic and Life Support Drugs Advisory Committee's Sept. 9 hearing, in
pdf (www.fda.gov/ohrms/dockets/ac/03/transcripts/3978t1.pdf)

Information on OxyContin from the U.S. Drug Enforcement Administration
(www.usdoj.gov/dea/concern/oxycodone.html)

Pain Relief Network (painreliefnetwork.org)

National Foundation for the Treatment of Pain (www.paincare.org)