The DEA's Big Chill Against Aggressive Pain Control

The New York Times Magazine published an important article today about pain control and the fear put into doctors by the Drug Enforcement Administration (DEA) that treating patients too aggressively with opioids (narcotics) could be dangerous to one's freedom.

The story, byline Tina Rosenberg, hits on all cylinders, too many in fact, to discuss fully here. The focal point tells of the imprisonment--effectively for life--of Ronald McIver, a doctor who was convicted of drug trafficking for too liberally prescribing opioids to treat severe chronic pain. (I take no position on McIver's case, but he is certainly not the only pain control doctor so imprisoned.) The article also does a nice job of educating the public about pain control, such as detailing how opioids are not addicting when used for a proper medical purpose of controlling pain, and how dosages can be titrated up slowly when needed without adverse impact on the patient. (Dr. Eric Chevlen and I discuss these matters more fully in our book Power Over Pain: How to Get the Pain Control You Need.)

The crux of the article involves the negative role the DEA plays--I hope inadvertently--in preventing people suffering from severe chronic pain from obtaining medically available relief. From the story:

In addition to medical considerations real or imagined, there is another deterrent to opioid use: fear. According to the D.E.A., 71 doctors were arrested last year for crimes related to "diversion"--the leakage of prescription medicine into illegal drug markets. The D.E.A. also opened 735 investigations of doctors, and an investigation alone can be enough to put a doctor out of business, as doctors can lose their licenses and practices and have their homes, offices and cars seized even if no federal criminal charges are ever filed. Both figures--arrests and investigations--have risen steadily over the last few years.

This is most unfortunate. Doctors should not be allowed to use their M.D. as a cover for drug pushing, of course. But they should also not be punished for prescribing aggressively in limited circumstances, when there is no other way to provide effective medical relief. And it seems to me, that the benefit of the doubt in borderline cases should be on the side of the doctors, not drug law enforcement.

Whether the DEA is actually being overly aggressive is a debatable matter, but it is entirely beside the point. The undeniable fact is that the DEA is perceived by many doctors as gunning for aggressive prescribers--resulting in a lamentable deterrence to the proper alleviation of pain. This means, as one case described by Rosenberg makes clear, that patients who could be virtually pain free, instead are forced to live every day as a grueling experience marred by agony and pain-caused physical limitations.

What is to be done? The law could--and should--get the DEA off of doctors' backs by declaring that aggressive pain control is a proper and legitimate use of controlled substances--even if it inadvertently leads to death--while at the same time, declaring that such use is not a license to prescribe these drugs to intentionally cause death.

One would think such a proposal would be uncontroversial. Alas. Several years ago, federal legislation to this effect known as the Pain Relief Promotion Act was filibustered to death by Oregon's Senator Ron Wyden--who warned that it would threaten Oregon's assisted suicide regime.

So, the DEA continues to chill proper pain control, and Oregon's doctors are free to help kill patients. But caught in between are tens of thousands of desperate people whose only hope for relief may be the type of doctors who are willing to prescribe aggressively, even at the risk of being put in jail.