Chronic Pain Management and the DEA

Stupidity (particularly when it isn’t my own stupidity) makes me angry. Governmental stupidity makes me even angrier. Judicial stupidity has a special ability to raise my ire above a threshold unknown to any individual who has ever ticked me off to any degree whatsoever. So pardon me while I rant about something that is peripherally related to migraines (bear with me and you’ll see the connection).

First of all, I need to tell you that there are a handful of people that are very important to me who suffer from multiple sclerosis. It kind of runs in the extended family, and our part of the country seems to be a hotbed for the disease, so I’ve known more people with MS than the average bear might expect.

This brings me to the story of Richard Paey, from Florida, who suffers both from MS and chronic pain from a spinal cord injury from an automobile accident decades ago. I heard of Mr. Paey’s story through the blogosphere, which led me to a web article posted by Maia Szalavitz, and finally a New York Times article by John Tierney.

The short version of the story is that Richard Paey was in a lot of pain from both MS and his automobile accident. Mr. Paey had obtained relatively large amounts of opioid painkillers using prescriptions. There is some question as to whether or not the prescriptions were valid or forged. According to the NYT article, Mr. Paey claims (along with back up from several of the pharmacists) that all of the prescriptions were given to him by his physician. His physician claims that some of the prescriptions were forged. The article by Maia Szalavitz suggests the doctor was “strong-armed” into that testimony by the Drug Enforcement Agency’s threats of being pulled into the case as an accomplice, but we’ll never know if that’s true.

A couple of apparent ironies about the case are that apparently one of the drugs that was taken into consideration for his trial and sentencing was off-the-shelf acetaminophen. The second irony is that now that he’s serving 25 years in federal prison for drug trafficking, the prison system has given him a morphine pump, which gives him a higher daily dose of stronger medication than he was getting in the first place.

I did some additional research because of this article. What I found was the DEA seems to employ a “take no prisoners” approach when they go about prosecuting drug traffickers. Normally, this would be a good thing, but there seems to be a grey area between the amounts of medication needed for chronic pain management and true drug trafficking, and from some of the accounts that I’ve read, the tactics being used don’t give much of an option for the physicians involved to fight the charges.

The worst part of it? Physicians who used to be willing to write scrips for pain management might not be as willing anymore, fearing retribution or storm trooper tactics from the DEA. Meaning a patient who used to have a legal venue for the pain meds now has to either suffer or look for an illicit source for their relief.