OPIATES, PAIN, AND DRUG LAWS

To the Editor:

Re "Trafficker or Healer? And Who's the Victim?" (Findings, March
27): As a primary care physician who now practices partly in a
hospice setting, I have gone from eyeing every request for opiates
with suspicion to viewing pain assessment as "the fifth vital sign"
to educating that there is no absolute upper limit to opiate dosing
to relieve suffering.

Reflecting on my experiences, some of my deepest regrets are not for
the patients whom I suspected might have been "drug seeking," but for
those who may have needlessly suffered because I was worried about
"how it might look" to colleagues, a third-party payer or a
regulatory agency to prescribe such a large dosage or quantity of
pain medication.

Helen Chen, M.D.

San Francisco