For people in the Middle East — and most of the rest of the world — mention of the US Department of Justice and the FBI probably conjures up images of Arabs being rounded up and jailed after the 9/11 attacks, people imprisoned at Guantanamo Bay, or prisoners being abused at Abu Ghraib.
But there is another part of the Justice Department that is little known outside the US. It is called the Drug Enforcement Administration and, since 2001 it has been cracking down on doctors who prescribe medications to relieve chronic pain, and the patients who depend on these drugs to live normal lives.
Here are two examples of the results of this aspect of America’s “War on Drugs”: Wheelchair-bound multiple sclerosis patient Richard Paey is serving 25 years in a Florida prison for “trafficking” 1/2 gram of OxyContin, a widely used pain medication, even though the prosecutor concedes that Paey never sold any of this medication. In prison, he now receives more pain-killing drugs than he was convicted of having.
Dr. William Hurwitz, a pioneering pain physician, was tried and convicted of violating the Controlled Substances Act — which is intended to curb the illicit use of drugs — and is serving a 25-year term in federal prison. He was also fined $2 million.
These are but two of hundreds of cases in which physicians have been put on trial for charges ranging from health insurance fraud to drug distribution, even to manslaughter and murder for over prescribing prescription narcotics. Investigators have also seized doctors’ homes, offices, and bank accounts, leaving them with no resources for their defense.
Starting in the mid-1990s, and ratcheting up in 2001, the DEA — part of the US Department of Justice (DOJ) — has been leading an aggressive effort to eradicate the illegal “diversion” of certain prescription painkillers. A particular target has been OxyContin, one of a class of drugs known as opioids.
In 2001, the DEA launched a campaign called the “OxyContin Action Plan”.
The DEA says the plan is necessary due to increasing abuse of prescription drugs, particularly by youth.
The agency, which has teamed up with state and local authorities, typically employs law enforcement methods developed in the government’s “War on Drugs”, including aggressive undercover investigation, asset forfeiture, and informers.
Critics charge that the DEA has focused too narrowly on doctors, exacerbating the already widespread problem of untreated or under-treated pain. Several doctors and many of their patients have already been sent to prison. The Village Voice newspaper reports that medical schools are now advising students to avoid pain management practice altogether.
The DEA maintains that only “criminal doctors” are being targeted, and that its efforts to prevent the sale of prescribed medications have no effect on the legitimate treatment of pain.
Ironically, the DEA crackdown comes at a time when the medical profession knows more than ever about how to treat the chronic pain that makes life intolerable — sometimes impossible — for the estimated 50 to 70 million Americans who live in chronic disabling pain. The programs also come at a time when there are more effective pain-killing drugs on the market and when the Internet makes it easier than ever to obtain them.
The DEA’s dilemma is separating legitimate prescribers and users from drug dealers.
In addition to Hurwitz, Dr. Ronald McIver is serving 30 years, Dr. Freddie Williams is serving life, and Dr. James Graves received a 62-plus-year sentence for diversion in 2002.
According to Prof. Libby, who has become an authority on the subject, “Many doctors have been convicted and almost no one has been acquitted.”
Richard Paey was convicted of fraudulently submitting multiple copies of opioid prescriptions to treat chronic pain. He was in New Jersey where his doctor treated him, but then moved to Florida where he was unable to find a physician to write prescriptions to treat his pain.
Frightened by what they term a “brutal display of executive power”, most doctors, including those in the field of pain management, have simply abandoned this sickest and most vulnerable segment of America’s population. Patients suffering from mild to moderate pain, and requiring low dosages of opioids may still find care, but those patients with high dosage requirements are increasingly shut out of care altogether.
In 2004 it was estimated that many of the 5,000 pain specialists in the United States would not prescribe opioids. Those few who do treat chronic pain with opioids impose severe restrictions on patients’ freedoms.
The DEA claims it investigates less than one percent of physicians who prescribe OxyContin or other drugs covered by the Controlled Substances Act. The agency reported arresting 34 doctors out of 963,385 registered doctors in 2003, for selling opioids to addicts or drug dealers for money, sex, or favors. That is less than 0.001 percent of the total number of licensed doctors, the DEA said. But critics dispute that figure.
Dr. Alexander DeLuca, MPH, a member of the American Academy of Preventive Health told this writer, “Relations between physicians and the DEA have probably never been worse in modern times.”
