The DEA War on Chronic Pain Patients

The DEA's intimidation tactics against doctors causes billions of dollars of additional healthcare expenses for patients, billions of dollars in lost productivity because of untreated pain, and is actively destroying or severely limiting the quality of life for tens of millions of people in America every single day.

• According to the American Academy of Pain Medicine, seventy-six million Americans suffer from chronic, daily pain, and at least nine million have daily pain that is severe enough to interfere significantly with their jobs and relationships. 
• An estimated 20% of American adults (61.5 million people) report that pain or physical discomfort disrupts their sleep a few nights a week or more. 
• The annual cost of chronic pain in the United States, including healthcare expenses, lost income, and lost productivity, is estimated to be $100 billion. 
• More than half of all hospitalized patients experienced pain in the last days of their lives and although therapies are present to alleviate most pain for those dying of cancer, research shows that 50-75% of patients die in moderate to severe pain. 
• In a recent survey, 50% of chronic-pain patients had, at one time or another considered suicide to escape the unrelenting agony of their pain. There are no statistics on the number of suicides attributable to untreated pain, but various studies carried out over the past decade have found that fear of pain is what lies behind the majority of requests for doctor-assisted death. 
• Untreated pain also raises blood pressure, and researchers have found that every 10mm increase in systolic blood pressure results, on the average, in a 40 percent increase in risk of stroke and a 30 percent increase in risk of heart attack.

The DEA campaign against prescription drug abuse has stigmatized patients in need of pain medication. DEA intimidation tactics and sting operations against doctors have created a climate of fear, with the predictable result that many doctors now won't prescribe opiates at all or are only willing to prescribe amounts that are totally inadequate. As a result, many more people die from not having the prescription pain medications they need, than die from the drug abuse the government is trying to prevent. The DEA is actually killing chronic pain patients by intimidating their doctors.
 

One of the major causes of those deaths is the overuse of OTC NSAIDS like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) by people who are desperate for pain relief. The Food and Drug Administration estimates that 200,000 cases of gastric bleeding occur each year, resulting in nearly 20,000 deaths. 
 

Background

Americans are a generous and compassionate people. But they have been brainwashed their entire lives by the constant drumbeat of anti-drug propaganda coming from drug warriors, law enforcement and the criminal justice system, and endlessly parroted by self-serving politicians and the media. 
 

Twenty years ago, the DEA made prescription drug abuse its primary mission after its survival was threatened because of its failure to have any measurable impact on the availability of street drugs. The DEA ginned-up a lot of bogus statistics about deaths supposedly due to prescription drugs by blaming deaths on prescription drugs if there were any narcotics involved, even if the drugs weren't the actual cause of death. Then they cranked-up their propaganda machine in concert with their allies in various public and private agencies who all have one thing in common; they owe their existence to the war on drugs. The media accepts press releases from these agencies and does stories on them without any critical examination of the claims being made. Mothers who lost their children to drug abuse are invited to testify before Congress, giving our representatives an opportunity to exploit their grief in a national spotlight for political gain.  
 

The DEA has focused on doctors who prescribe a lot of pain medications to chronic pain patients because they are easy targets. Doctors keep good records and they have a lot of assets that can be seized. And the DEA is far more interested in seizing assets than they are in seizing illegal drugs. Doctors who prescribe narcotics are now living under the constant threat that they will be arrested by the DEA and prosecuted as if they were running a drug cartel.

Once arrested and stripped of all his assets, a doctor will be charged with tens, if not hundreds of individual crimes, so that they will be under tremendous pressure to plead guilty to lesser charges in order to avoid a lengthy prison sentence. Many doctors who are totally innocent cave-in and accept a plea bargain because they know the odds are stacked against them.

In a criminal trial, a jury of ordinary people are asked to decide whether a doctor's care was appropriate, based on the testimony of competing experts on both sides. Prosecutors who want to portray a compassionate doctor as a common drug dealer will hold up bags of pills and argue that the doctor was operating "outside the bounds of legitimate practice." One way they do that is by trying to confuse the jury about what the legal definition of "Standard of Care" really means.

"Standard of Care" aka Reasonable Physician Standard of Care is legally defined as being based on what the science (as reflected in the medical texts and journals) indicates is appropriate care.

But prosecutors and their hired-gun experts attempt to use "Community Norms" to show that the doctor is operating way out on the fringes -- beyond what "most doctors" would do. Community Norm is defined as what most doctors would do, but most doctors are afraid to do the right thing because of the chilling effects of DEA intimidation tactics.

Doctors who aggressively treat the patients who need the most pain relief are actually doing the right thing, based on any reasonable interpretation of the science. That puts those doctors outside the norm, and in the DEA's crosshairs, because most doctors won't prescribe ANY narcotics for chronic pain. Only a small percentage are willing to prescribe narcotics for the treatment of chronic pain, and the overwhelming majority of those will only prescribe to their comfort level, rather than their patient's. The tiny percentage of doctors who are courageous enough to put their patients welfare first are under constant surveillance by the DEA and routinely subjected to DEA sting operations.

You can make a difference, and you should try, because you and everyone you care about is at risk for having their life destroyed by untreated pain. Do not accept without question what is being spoon-fed to you daily by those who profit from denying pain medications to people who need it the most.

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News:

Wikileaks Cables Portray Expanded Reach of Drug Agency

The Drug Enforcement Administration has been transformed into a global intelligence organization with a reach that extends far beyond narcotics, and an eavesdropping operation so expansive it has to fend off foreign politicians who want to use it against their political enemies, according to secret diplomatic cables. In far greater detail than previously seen, the cables, from the cache obtained by WikiLeaks and made available to some news organizations, offer glimpses of drug agents balancing diplomacy and law enforcement in places where it can be hard to tell the politicians from the traffickers, and where drug rings are themselves mini-states whose wealth and violence permit them to run roughshod over struggling governments.   

Report finds DEA Losing More Guns 

The Drug Enforcement Administration is losing more guns than it was about five years ago, the Justice Department's inspector general said. Auditors said the DEA lost 22 firearms and had an additional 69 stolen over the 5½-year period. The stolen weapons included pistols, rifles, shotguns, and a submachine gun.

The majority of stolen guns had been left in an official's car, despite a policy prohibiting leaving a weapon unattended in a vehicle. The report cited examples of guns stolen from cars parked outside restaurants, hotels, schools and gyms. Some agents had their guns taken from their cars while they were shopping or getting coffee. One firearm was stolen while the car was at the body shop.
 

Audit Faults DEA Mishandling of Cash Seizures

U.S. Department of Justice
Office of the Inspector General

"For most seizures we tested, we found no documentation indicating that a witnessing agent or task force officer was present at critical stages of the cash handling process. Further, we found many instances in which agents and task force officers generally did not count the seized currency; did not provide a receipt to the subject from whom the currency was taken; did not complete documents transferring custody of the currency to an evidence custodian; and did not record the receipt, transfer, or disposal of the currency in a temporary or permanent control ledger."   

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DEA Follies:

The Prescription Drug Rap From a DEA web site aimed at teens

What's up with Prescription and
Over-the-Counter Drugs?

Prescription drugs, they treat the pain,
If you use too much, they will give you no gain.
Con-cen-tra-tion - a thing they can do,
Some help you think and feel better too.
"Don't abuse them," that's the prescription.
"Don't abuse them," the right decision!

 DEA agent shoots himself in the foot
"I'm the only one in this room professional enough,
that I know of, to carry a Glock 40." BLAM!

Update - Lee Paige, the DEA agent who shot himself in the foot while demonstrating gun safety to schoolchildren was only suspended for five days. This real-life "Barney Fife" then sued the DEA over release of the video that made him famous. His law suit was dismissed by a federal judge.

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The DEA, Diversion and the War on Drugs:

The DEA War on Hydrocodone

The DEA wants to classify hydrocodone the same way it does Oxycodone. If hydrocodone became less available, we could expect potentially 8,000 more deaths from stroke and heart attack every year. And, although there's no way to reasonably estimate the number of people who will suffer bouts of depression, thoughts of suicide and actually commit suicide after being denied adequate pain medication because of the DEA's increasingly draconian measures, it's safe to assume that number will be in the millions...
 

Reefer Madness: The Federal Response to California's Medical Marijuana Law
Marijuana is unique among illegal drugs in its political symbolism, its safety, and its wide use. California's law seems to have engendered a uniquely harsh federal response because California is a large, trend-setting state; because its new marijuana law is very broad as compared with others; and because the law was passed by popular referendum...
 

The Pain Crisis in America
There is a Pain Crisis in America. Its primary manifestation is the routine and widespread under-treatment of pain, especially chronic, non-cancer pain. Other manifestations include a severe and growing shortage of physicians willing to prescribe morphine and related opioid analgesics, the widespread use of more toxic and less efficacious classes of medications in an effort to avoid opioids, and the profound distortion of medical education and of the doctor-patient relationship...
 

Victimized Doctors
Doctors throughout the country are being targeted by the DEA for helping patients manage crippling pain with prescription drugs. There is no presumption of innocence. Collateral damage to patients and physicians' families is the norm. "Our office will try our best to root out (certain doctors) like the Taliban" boasted US Attorney Gene Rossi..
 

American Medical Association (AMA) Policy Statement on Pain Management Using Opioid Analgesics
Preventing drug abuse remains an important societal goal—it should not hinder patient’s ability to receive the care they need and deserve or discourage physicians from prescribing pain medications when medically appropriate. The AMA is committed to the goal of protecting the legitimate use of prescription drugs for patients in pain...

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The DEA War on Hydrocodone

 

 

The DEA wants to classify hydrocodone the same way it does oxycodone, a more powerful analog that is the active ingredient in the long-lasting painkiller Oxycontin. Oxycontin prescriptions cannot include refills. Oxycontin or hydrocodone alone are rarely the sole cause of a drug-induced death. More than 95 percent of these deaths are caused by "polypharmacy," the ingestion of multiple illicit compounds, usually laced with a lot of quite legal booze.

Picking on one drug won't do the trick, but picking on hydrocodone is a particularly bad idea, because the DEA's proposals could well kill more people from pain than they save from abuse.

How much pain and suffering does hydrocodone mitigate? There were 100 million new prescriptions for the drug last year in the United States, given to 38 million patients. (This doesn't even count in-hospital use.) Hydrocodone is by far the most prescribed drug in the nation.

Because there will be no more refills, DEA's proposal means at least 300 million office visits per year (figuring that most chronic pain prescriptions are refillable twice). Nowadays, one just doesn't walk in and out of a doc's office. Most pain doctors are so busy that appointments must be made months in advance, and appointment, travel and waiting easily burn half a day. That's 150 million worker days lost. Based upon average annual wages, employers will pay ( and you and I will shoulder ) about $13 billion in wages for doctor-visit induced absenteeism. And the office visits will add another $20 billion in cost, payable through the patient's insurance or someone else's taxes.

Add this to the fact that, according to Katherine Foley, a pain expert at Sloan-Kettering Cancer Center, pain already costs Americans $100 billion per year in treatment costs and labor-related losses. Making pain relief harder to get will only make it more expensive.

How risky is hydrocodone? According to the Drug Abuse Warning Network, a systematic effort to procure objective information on drug-related deaths, hydrocodone showed up in 46 bodies last year in Las Vegas, a town surely prone to a bit of drug abuse. The number of hydrocodone pills prescribed there in 2001 was around 27 million, and this doesn't even count the huge number that fly in with tourists, gamblers and others who engage in risk-taking behavior every weekend. I'd say it's a good bet that more people die in legal casinos and brothels in southern Nevada from heart attacks than are killed by hydrocodone.

Some other state data can be used to make fuzzy estimates of abuse-related deaths. In 2002, there were 150 findings of fatal concentrations of hydrocodone in postmortem examinations in Florida. Assuming conservatively that this may catch half the deaths, and way too conservatively that "Miami Vice" Florida is typical, this would maximize the number of deaths per year associated with fatal concentrations of this drug at around 6,000 nationwide.

Given the problem of polypharmacy, it's charitable to assume that the DEA's proposal may prevent half those deaths. Are 3,000 deaths pretty high overhead for pain relief? Well, consider NSAIDs. About 16,000 people who use these medications for arthritis alone die each year, due to the drugs' propensity to enhance internal bleeding. It would seem from this that DEA would save a lot more lives if it made ibuprofen harder to get, so that those with pain would have to switch to hydrocodone or oxycodone.

But that may be just one tip of the iceberg. Pain raises blood pressure and researchers have found that every 10mm increase in systolic blood pressure results, on the average, in a 40 percent increase in risk of stroke and a 30 percent increase in risk of heart attack for your age class.

So if hydrocodone became less available, we could expect potentially 8,000 more deaths from stroke and heart attack every year. And, although there's no way to reasonably estimate the number of people who will suffer bouts of depression, thoughts of suicide and actually commit suicide after being denied adequate pain medication because of the DEA's increasingly draconian measures, it's safe to assume that number will be in the millions.

Compare that with about 3,000 deaths that can prevented by the DEA's proposal. Those deaths are very unfortunate, but any "solution" that punishes the 38 million pain patients who use hydrocodone safely is not a reasonable solution.

Adapted from an article by Patrick Michaels, a senior fellow in environmental studies at the Cato Institute.

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The Pain Crisis in America

 

 

There is a Pain Crisis in America. Its primary manifestation is the routine and widespread under-treatment of pain, especially chronic, non-cancer pain. Other manifestations include a severe and growing shortage of physicians willing to prescribe morphine and related opioid analgesics, the widespread use of more toxic and less efficacious classes of medications in an effort to avoid opioids, and the profound distortion of medical education and of the doctor-patient relationship.

How large a problem is under-treated pain in America? In a 2001 article in the Journal of the American Medical Society (JAMA), Brian Vastag reports on the work of Richard Brown and colleagues who stated, at a National Institute on Drug Abuse (NIDA) symposium in April 2001, that there was widespread acknowledgment that both acute and chronic pain are under-treated. Brown estimated that more than 17% of Americans have serious chronic pain and that many go untreated and many more are under-treated. This is the pain crisis in America.

In an attempt to gauge the extent of the problem, these researchers developed a survey that measured the prescribing practices for benzodiazepines (Valium and related sedatives) and for opioid analgesics by different groups of physicians in response to variations of a single presented case. The physicians' prescribing decisions were then compared with recommendations from a panel of pain management experts. The findings were stark:

While the expert panel recommended that virtually all patients with [common idiopathic back pain] who do not respond to other treatments be given an opioid analgesic, only 20% of physicians said they would actually write that prescription... "It suggests there's a lot of unnecessary suffering," said Brown. To combat the problem, he called for increasing the amount of medical school education devoted to pain management, from the typical 2 to 4 hours to 16 or 20. 

None of this is new. For decades, researchers have noted this discrepancy between how chronic pain should be treated and the dismal state of the art as practiced in the U.S., and they commonly call for more and better education of physicians. But is the pain crisis in America simply a problem of the acquisition and application of medical knowledge? And if so, why have the impressive and consistent educational campaigns directed at this problem in recent decades failed to yield the expected changes in medical practice in the U.S.? 

The historical record strongly suggests a deeper and far more disturbing root cause of our current pain management predicament. In the years after 1914, the Narcotics Division of the Treasury Department, progenitor of today's Drug Enforcement Agency (DEA), brought a series of test cases against physicians under the Harrison Act. Through the courts, drug prohibitionists achieved the criminalization of drug users and of the doctors who would treat them as patients and as human beings worthy of the same individualized medical care as any other sufferer in a free society. This wide scope of law enforcement responsibility was far beyond that legislated by Congress when it passed what appeared to be a tax act in 1914. 

This historical period marks the invention of a perpetual national drug crisis which has ever since been claimed as the special national interest justifying the regulation of opioid analgesic medications and other dangerous drugs' by a federal law enforcement agency. In so doing, this agency has usurped the right constitutionally reserved to the states to otherwise license and regulate medical practice in that most fundamental, archetypal, and timeless of all the medical arts: the skillful application of opioid analgesia towards the relief of human pain and suffering. 

While opium and its derivatives are among the most ancient and well understood and safest pharmaceuticals mankind has ever developed, problematic use has been a source of personal tragedy in the lives of individuals throughout recorded history. However, before about 1920, there was no domestic drug subculture, no drug problem, no criminal black market, no drug cartels, no state-sponsored hounding and jailing of drug users and pain patients and of their physicians, no public outcry for the politicians of the day to "get tough on drugs." In fact, there is no credible record of a domestic drug problem prior to the perversion of the Harrison Act in the courts in the years after 1914 although there were many more opiate dependent people, both in absolute numbers and as a percentage of the population, than there are today. It has been estimated that in the 1880s some 4 per cent of the population of the United States used some kind of opiate for non-medicinal purposes.  

For a sense of perspective, consider that modern heroin use peaked in the late 1980's at approximately 326,000 (past month) users, or about 0.1 percent of the population, according to National Household Survey on Drug Abuse data. It is notable that, in the decades around the end of the Nineteenth Century, America supported large and powerful popular social movements against alcohol and tobacco use which were widely (and correctly) perceived as true national public health scourges. There is no record of any anti-opioid movement or opioid prohibition movement of similar significance because this class of substance was not viewed (again correctly) to be a social scourge or significant public health menace. 

The root cause of the widespread under-treatment of pain can be traced directly to the systematic, nationally coordinated, relentless harassment, arrest, and prosecution of thousands of American physicians, many of whom had been engaged in nothing other than the standard care of pain and addiction of the day. This pogrom has continued, unabated, for almost ninety years. 

The proximate cause of the pain crisis arises from what is known as the "chilling effect," a phrase which describes the grotesque distortion of the norms of medical practice and the violation of the doctor-patient relationship that results from the withdrawal of physicians from the appropriate treatment of pain due to fear of litigation, loss of livelihood, and incarceration. 

In a 2003 press release entitled "The Myth of the Chilling Effect," the DEA denied the possibility that its actions against physicians could have such an effect, arguing that DEA only brings actions against a miniscule proportion of doctors, therefore actions against doctors for violations of the Controlled Substances Act (CSA) cannot be causing other doctors to seek to avoid such actions by failing to use opioid analgesics appropriately or by refusing to prescribe them at all. We will analyze this document very carefully later in this paper and reveal it to be so much dissembling gibberish.

What each of us as members of a free and democratic society, governed by our own consent under the Constitution and the Bill of Rights, with an understanding of the meaning of federalism, States rights, the Fourth Amendment right to privacy, and the separation of powers, has to decide is:

Was there ever, or is there now, a national problem caused by domestic licit and illicit drug use of such dire import and magnitude that it might justify placing medical doctors and researchers under the direct regulatory control of adversarial federal law enforcement officers with no medical training? Should the DEA, a federal law enforcement agency with a Fiscal Year 2004 Office of Management and Budget (OMB) rating of ZERO, have the power to prescribe and proscribe the medical behavior of individual physicians, down to the level of judging individual patient medication regimens, and to grossly distort the norms of medical practice in entire specialties of medicine? 

 

If there is a national drug problem that does warrant eighty years of a war on drugs / war on doctors and the systematic state sanctioned abuse of pain patients, drug users, and their families, what exactly is the nature of the problem and how severe is it? Compared to what? 3. Where do we go from here? Does the DEA have a legitimate role in making policy on issues which are considered to be medical and public health matters by the vast majority of the nations of the world? Is negotiating towards achieving consensus with such people possible? Is it strategically, morally and ethically advisable? There have been several "Pain Summits" over the years and grand "consensus documents" and "clinical guidelines" have been proclaimed, and yet the war on doctors continues unabated. So we ask, does the DEA negotiate in good faith?

http://www.doctordeluca.com

 
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AMA Policy Statement on Pain Management Using Opioid Analgesics

 

 

Unbalanced and misleading media coverage on the abuse of opioid analgesics not only perpetuates misconceptions about pain management; it also compromises the access to adequate pain relief sought by over 75 million Americans living with pain.

In the past several years, there has been growing recognition by health care providers, government regulators, and the public that the under-treatment of pain is a major societal problem.

Pain of all types is under-treated in our society. The pediatric and geriatric populations are especially at risk for under-treatment. Physicians’ fears of using opioid therapy, and the fears of other health professionals, contribute to the barriers to effective pain management.

In 2001, in an unprecedented collaboration, the US Drug Enforcement Administration (DEA) joined 21 Health Groups, including the American Medical Association, in calling for balanced policy governing prescription pain medications. In August 2004, the DEA issued a document entitled Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel, however, the agency withdrew its support for the document less than 2 months later saying that it "contained misstatements" and "was not approved as an official statement of the agency."

The AMA supports the position that (1) physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain should not be subject to the burdens of excessive regulatory scrutiny, inappropriate disciplinary action, or criminal prosecution. It is the policy of the AMA that state medical societies and boards of medicine develop or adopt mutually acceptable guidelines protecting physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain before seeking the implementation of legislation to provide that protection; (2) education of medical students and physicians to recognize addictive disorders in patients, minimize diversion of opioid preparations, and appropriately treat or refer patients with such disorders; and (3) the prevention and treatment of pain disorders through aggressive and appropriate means, including the continued education of physicians in the use of opioid preparations.

The Federation of State Medical Boards’ Model Guidelines for the Use of Controlled Substances for the Treatment of Pain, encourage adequate pain management and address physician concerns about disciplinary actions by medical boards. These guidelines were recently updated to ensure currency and adequate attention to the treatment of pain. Policies and guidelines of the American Pain Society, the American Academy of Pain Medicine, the American Geriatric Society, and the American Society for Addiction Medicine also encourage the appropriate use of opioid analgesics for pain management.

At its annual policy-making meeting in the summer of 2003, the AMA House of Delegates adopted policy recommendations stating their opposition to the harassment of physicians by DEA agents in response to the appropriate prescribing of controlled substances for pain management, as well as to the inappropriate use of 21 Code of Federal Regulations Section 1306.04 or any other rationale that would involve placement of licensure restrictions on physicians who use opioid analgesics and other pain-reducing medications appropriately to treat patients with pain. The AMA requests that state medical and specialty societies submit examples of physicians who allegedly have been harassed by DEA agents for appropriate prescribing of controlled substances for pain management to the AMA's Office of General Counsel.

The AMA is committed to the goal of protecting the legitimate use of prescription drugs for patients in pain. And education is the best medicine. To this end, the AMA has created a national Pain Management CME program for physicians to address many of these issues. The review board for this activity consists of expert reviewers from 16 medical specialty societies and other professional health care organizations. The CME program was funded through an unrestricted educational grant from Purdue Pharma, L.P.

In addition, the American Academy of Pain Medicine recently announced a new initiative, named TOP MED (Topics in Medicine), a comprehensive "virtual textbook" on treating patients of all ages suffering from different types of pain. The web-based, self-directed textbook will be made available free of charge to medical students across the country in the fall of 2004.

Preventing drug abuse remains an important societal goal—it should not hinder patient’s ability to receive the care they need and deserve or discourage physicians from prescribing pain medications when medically appropriate. 

 
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