BALANCING LAWS AND TREATMENT

To the Editor:

Doctors on the front lines of pain management are often caught between
a rock and a hard place. On one side there is the real possibility of
improper drug diversion and sales, and on the other the potential for
failing to alleviate a patient's suffering. A physician can end up a
defendant in a criminal trial or a defendant in a civil lawsuit.

Chronic pain is not like an infection. There aren't concrete tests
that can prove its existence. One must rely on the patient's
description. There are inherent risks, but collaborative groups of
physicians, pharmacists and nurse practitioners have developed some
truly effective ways of preventing drug diversion and setting
standards for prescribing them.

Peter Nelken

San Francisco