The Painful DEA

Everybody knows what a "symptom" is. It's an indicator of something else. Some symptoms, such as a runny nose, can indicate something as trivial as a head cold. Other symptoms point to far more debilitating or even deadly conditions.

This article is about the Drug Enforcement Administration (DEA) inflicting pain on both patients and doctors – and what this symptom might mean.

Way back during the so-called Progressive Era a century ago, a de facto alliance of physicians and bureaucrats undertook to regulate the possession and distribution of drugs, especially those that affected the sensation of pain.

Their intentions, like those of the temperance movement, were humane, at least in theory. They had seen what morphine addiction had done to a generation of Civil War veterans; they'd watched too many middle-class matrons quietly wasting away on laudanum, an opium preparation. They wanted to help.

Whether they did or did not help is debated to this day. But never could the most ardent Progressive do-gooder have imagined that today, anti-drug laws would be used by overzealous bureaucrats and frenetic enforcers to deny patients desperately needed treatments, or drive physicians out of medical practice or send them to prison.

No, we're not talking here about legalizing marijuana or about the tiny percentage of doctors who criminally abuse their prescription pads and belong in jail. We're talking about government agents making it ever more difficult for patients in severe pain to get relief as these government officials take unto themselves the "responsibility" of keeping patients from becoming "addicted" to drugs that allay their suffering and enable them to survive.

Publicly, the feds make all the right noises. Asa Hutchinson, former DEA director, speaking to a meeting of the American Pain Society on March 14, 2002, told doctors:

"... we trust your judgment. You know your patients. The DEA does not intend to play the role of doctor. Only a physician has the information and knowledge necessary to decide what is appropriate for the management of pain in a particular situation. The DEA is not here to dictate that to you. .... We never want to deny deserving patients access to drugs that relieve suffering and improve the quality of life."

But consider what the drug enforcers actually do:

Mere anecdotes? Perhaps. But then, the plural of "anecdote" is "data." And there are many, many more examples.

Other government actions "send the same message." At a pain management conference sponsored by the Pima County Medical Society of Tucson, Ariz., speakers such as David Greenberg, M.D., MPH, chief investigator for the Arizona Medical Board, and Neil Irick, M.D., a pain specialist from Bloomington, Ind., told doctors to protect themselves by using surveillance cameras and urine drug screens to make sure each patient is as "clean" as he or she claims to be.

Further, to make sure the patient isn't importing somebody else's clean urine, they advised doctors to frisk patients before they give the urine specimen and then to maintain a chain of custody for the specimen, the same way police treat specimens from criminal drug suspects.

In other words, doctors should consider their patients to be criminal suspects until proven innocent.

The Association of American Physicians and Surgeons (AAPS) is now warning doctors to avoid medicines out of favor by DEA officials and to avoid prescribing more medicine than the DEA finds "usual" lest more doctors suffer similar, painful fates.

Again, we're not talking here about street drugs. We're talking about doctors prescribing legal drugs to patients who may not be able to survive, let alone function, without them.

For example, some patients with cancer pain lose their appetite and can't keep food down; without adequate and appropriate treatment for the pain, these people starve to death and die quickly. But with adequate treatment, many of these same people regain their appetite and strength, and live for many years.

And as the "guilty until proven innocent" standard comes to apply to doctors as well as patients, more and more physicians begin to practice that ultimate form of "defensive medicine" – quitting their pain management practice or getting out of medicine entirely.

But the problem goes much deeper than out-of-control drug cops. The government is relentlessly forcing the American physician to become the servant of the state, as hyper-regulated caregiver and as on-call policeman, under constant threat of criminal prosecution.

As usual, we recommend that you write the president, senators and representatives in Congress and tell them to stop treating doctors as criminals.

Now, given these symptoms, ask yourself: "Where does it hurt?"

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Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical- legal issues. Robert J. Cihak, M.D., is a past president of the Association of American Physicians and Surgeons.

Contact Drs. Glueck and Cihak by e-mail.