DOCTORS' GROUP ADVISES PHYSICIANS TO AVOID TREATING PAIN WITH OPIATES

Cites Persecution of Pain Doctors - Tucson Case Illustrates Point

Prompted by an ever-mounting list of physicians charged with over-
prescribing opiate painkillers and the indictment of a Tucson physician in
March, a Tucson-based medical association representing some 5,000 doctors
has warned its colleagues not to prescribe opiates for pain relief and to
take elaborate -- and expensive -- precautions if they do. On July 1, the
Association of American Physicians and Surgeons
(http://www.aapsonline.org), a free market-oriented group, sent out a
memorandum titled "Advice to Doctors Re: Pain Management (or What the
Government Has Taught Doctors)."

"If you're thinking about getting into pain management using opioids,
DON'T," said the AAPS memo. "Forget what you learned in medical
school -- drug agents now set medical standards. Until wrongs are
righted and procedural changes are made, physicians have little choice
other than to be unusually suspicious of new patients, to require
unnecessary and expensive tests, to waste time on excessive
documentation, or to turn away suffering patients, even if they think
the patients may not find anyone else to treat them.

If you are already prescribing opioids," the memo continued:

* "Beware of new patients. If you accept a new patient, do background
checks, demand old records before writing the first Rx, obtain urine
screens and get them to sign opioid contracts. It is safer to turn
them down, explain why, and give them an action item (call their
congressman, for example).

* "Do thorough physicals, even if unnecessary and not
helpful.

* "Make voluminous notes.

* "Exercise zero tolerance for patient slip-ups (such as losing a
prescription).

* "Beware of any patients with a history of drug abuse. Even if now
clean and in genuine pain, they might be induced by government zealots
to testify against you to save themselves from imprisonment on drug
charges.

* "Refer patients early and often to addictionologists, orthopedists,
pain specialists, psychologists, regardless of expense or your opinion
of helpfulness.

* "Keep a low profile and beware of saying anything that might offend
an official of law enforcement, the licensure board, or the state
medical society.

* "Never forget that you could be held to a standard of strict
liability for any patient misbehavior or for any bad outcomes such as
death, no matter the cause and without regard to the culpability of
the patient or his associates. Remember, your medical decisions will
be reviewed by drug agents who will decide if your actions were
medically reasonable.

* "Consider phasing out this part of your practice, giving patients
plenty of time to find another doctor."

"We don't really want to give doctors this advice," said Dr. Jane
Orient, executive director of the AAPS, "but something has got to be
done. A lot of doctors are afraid to prescribe opiates even for
desperately ill patients -- it's not worth spending the rest of your
life in prison for prescribing pain medications," she told DRCNet.

That's the prospect confronting Tucson pain management specialist Dr.
Jeri Hassman (http://www.drhassman.com), who faces a 66-count
indictment charging her with prescribing opioid painkillers to six
patients without a legitimate medical reason. Those drugs included
morphine, methadone, Vicodin and Oxycontin. She is also charged with
defrauding TRICARE, a managed health-care group serving US military
retirees and their families, and is facing DEA administrative hearings
and a state medical board investigation, according to her lawyer,
former US Attorney for Arizona Bates Butler. According to the DEA and
federal prosecutors, Dr. Hassman's patients included a number of
suspected "doctor shoppers," or people who go to multiple doctors
seeking to obtain large amounts of controlled substances.

"Why in the sam hell didn't they go to her if they thought some of her
patients were doctor-shopping?" fumed Butler. "They didn't inform her
of a potential problem, they just sent in an undercover agent claiming
he was in pain."

There is a common practice across the country that seems designed more
to cripple doctors than to achieve justice, Butler said. "What happens
is the DEA suspends the doctor's license to prescribe, then the doctor
appeals and the case is set for an administrative hearing. Now the
doctor has to reveal to the DEA the specific defense to the charges,
which effectively wipes out your Fifth Amendment privilege," he
explained. "After the DEA gets a look at your defense, but before the
actual administrative hearing, here comes a criminal indictment. Now,
the doctor's lawyer is going to tell him to put the administrative
appeal on hold because there are more serious matters to deal with.
So what we have is the DEA forcing doctors to spend time and money to
defend themselves at these administrative hearings, while the DEA uses
that process to build a criminal indictment. And, of course, there
are also state medical board hearings, so it's a triple whammy, and
it's an abuse of civil proceedings by the DEA."

At a press conference June 26 in Tucson, Dr. Hassman told reporters
she had spent $100,000 on her defense so far and feared the bill could
reach half a million dollars. While Dr. Hassman's practice remains
open, her employees have had to take pay cuts, she said. And while
Dr. Hassman conceded that there are people who "doctor shop" to seek
drugs, she said the DEA should work with doctors to identify them
instead of targeting doctors. And, she said, DEA efforts to thwart
abuses should not get in the way of legitimate medical needs. "You
cannot ignore there are millions of people who suffer severe and
chronic pain," she said.

Dr. Hassman feels alone, Butler said, but her case is not unique.
According to the AAPS, there have been at least 32 similar
prosecutions of pain management specialists in recent years. Nor is
Dr. Hassman alone professionally. At least four Tucson-area pain
specialists are prepared to testify that Hassman was engaged in
legitimate medical practices, including local pain treatment expert
Dr. Jennifer Schneider and the immediate past president of the Arizona
Medical Association, Dr. Richard Dale.

And while the Arizona Medical Association was reluctant to comment
directly on Dr. Hassman's case, the group's executive director, Chic
Older, told DRCNet the issue of legitimate pain treatment was becoming
increasingly important. "We are watching to see what will happen,"
Older said. "Our medical association is on record saying we feel
physicians ought to be able to act in the best interests of their
patients. We don't think physicians should have to worry about losing
their license for treating a dying patient in intractable pain.
Sometimes there are cases whose outcome really sets a marker, and this
could be one of them," he said.

Regardless of the outcome in this particular case, said Older,
prosecutions like this one can deter physicians from properly treating
pain. "This is part of the criminalization of medicine," he said,
"and that has a chilling, chilling effect on physicians' willingness
to prescribe necessary medications. The whole notion of the
enforcement and judicial arms of government overseeing physicians and
looking for criminal intent is becoming a very significant issue in
this country," Older said.

Also attending Dr. Hassman's press conference were about a dozen of
her former patients, who passionately defended her. One of them, Don
Hayden, 48, told reporters he had been bedridden with chronic pain for
years before finding Dr. Hassman. "She prescribed the proper pain
medication to make me a functioning member of this society," Hayden
said. Other patients said they were having trouble getting the
medications they need since Dr. Hassman's certificate to prescribe was
suspended by the DEA.

"The DEA says the justification for these arrests of doctors is the
public health," Bates said, "but Dr. Hassman had over 200 patients who
were receiving controlled substances for pain relief. What about the
public health when 200 patients can't go to their doctor? What makes
this even more frustrating is that of those patients of Dr. Hassman
who have managed to find another doctor, 97% of those we can find are
now on the same or higher doses of controlled substances."

"This is a serious problem," said AAPS' Dr. Orient. "We have
physicians being prosecuted like drug kingpins. We need real legal
reforms so that a doctor who gets taken in by an undercover agent or a
talented actor does not face life in prison. We need a nationwide
educational program about the difficulty patients are already having
getting pain medications. It's only going to get worse," she said.
"Doctors need to be seen as allies in the war against drug diversion,
not the enemy. Doctors are not cops, they don't have lie detectors.
If law enforcement was seriously interested in stopping drug
diversion, it would work with doctors, not target them."

"They've already lost the war on drugs," said Bates, who spent a
career prosecuting drug cases as US Attorney. "Now they want to turn
it into a war on doctors. There's a certain amount of ego
gratification in this for prosecutors," he said. "It's much more
exciting to take down a doctor, a lawyer, or some other professional
than just to prosecute another kid caught coming across the border
with a backpack full of dope."