Four years ago, the DEA worked with Dr. Russell K. Portenoy, chairman of the pain medicine department at Beth Israel Medical Center, to develop pain medication guidelines for both doctors and law enforcement officials. These guidelines were intended to reassure physicians that they had nothing to worry about when they prescribed pain medications as long as they did not “knowingly and intentionally” prescribe drugs for illegitimate reasons. The guidelines also cautioned narcotics agents not to investigate doctors simply because they prescribed large quantities of pain medications.
That all sounds good, right? Well, it might have been except for the fact that the DEA suddenly withdrew the guidelines and began prosecuting doctors in a nationwide campaign against the use of powerful analgesics in the treatment of patients with severe chronic pain. (Read the DEA guidelines as written before they were withdrawn and amended.)
One of those physicians, Dr. William Hurwitz, is going through a second trial, which began Monday. He is charged with 50 counts of unlawfully prescribing opioid pain medication. In 2004 Dr. Hurwitz was convicted and sentenced to 25 years in prison for drug trafficking and other charges. However, in August 2006, the Fourth Circuit Court of Appeals unanimously overturned Dr. Hurwitz’s original conviction because the judge in that case improperly instructed the jury to ignore whether Dr. Hurwitz had acted in good faith.
I don’t know all of the details of this case, so I can’t say whether Dr. Hurwitz knowingly prescribed opioids for drug addicts, was careless in his prescribing, or was simply a compassionate physician trying to care for what he believed to be patients in severe pain. This is about much more than this one case. What disturbs me is that in the past three years, there has been an eightfold increase in physician prosecutions. Now doctors are more reluctant than ever to prescribe adequate pain medications for their patients for fear of being prosecuted.
An estimated 50 to 75 million Americans live with chronic pain every day. Untreated pain is considered to be this country’s largest health problem. More days are lost from work every year due to pain than due to cancer and heart disease combined.
So what has happened to the Decade of Pain Control and Research? Six years into the decade, we’re fighting just to hold our ground. Doctors, who should be focused on finding better ways to treat their pain patients, are instead forced to withhold certain treatments for fear of ending up in prison. The question is, who should be deciding what treatment pain patients need –– doctors or prosecutors?