Feature: Pain Doctor and Patient Advocates Get a Congressional Hearing… Finally
For the first time in more than a decade, the Drug Enforcement Administration's (DEA) heavy-handed intrusion into the field of medicine came under congressional scrutiny last week. The broad-ranging review of the DEA's regulation of medicine came at a July 12 hearing before the House Judiciary Subcommittee on Crime, Terrorism, and Homeland Security chaired by Rep. Bobby Scott (D-VA).
While the hearing also included testimony and members' questions about the DEA's role in pursuing medical marijuana dispensaries and blocking marijuana research (see this newsbrief), as well as its apparent underestimation of the amount of pseudoephedrine needed for legitimate commercial and medicinal uses, testimony by Siobhan Reynolds of the pain patients and doctors advocacy group Pain Relief Network and attorney and chronic pain advocate John Flannery put the issue of the federal prosecutions of doctors who prescribe high-dose opioid pain medications front and center.
The hearings gained an added sense of timeliness the following day, when nationally-known pain management physician Dr. William Hurwitz was sentenced to five years in prison on drug trafficking charges. Hurwitz had originally been sentenced to 25 years in prison, but his original verdict was overturned and he was convicted of 16 drug trafficking counts in an April retrial. While pain patient advocates and Hurwitz supporters believe he should never have been convicted at all, they viewed the much shorter sentence -- which with time-served could see Hurwitz free in 17 months -- as a victory of sorts.
Still, Hurwitz remains behind bars for what is at best laxness in dealing with some patients who lied to him and resold drugs he prescribed them for chronic pain. As such, he is emblematic of the growing number of physicians who have been persecuted and prosecuted by the Justice Department and the DEA, as well as state-level prosecutors who have taken their lead from the feds.
"The subcommittee has received numerous complaints about the DEA's regulation of medicine," said Rep. Scott as he opened the hearing. Turning to prescription drug abuse, Scott noted that, "When it was first introduced, OxyContin abuse became rampant in such areas as Appalachia and rural New England. DEA responded by adopting the OxyContin action plan, which involved prosecuting medical doctors who prescribed high doses of painkillers. The DEA claims that this policy was not intended to impact the availability of legitimate drugs necessary to treat patients; however, the evidence suggests that the DEA's decision to prosecute doctors has created a chilling effect within the medical community, so that some doctors are unwilling to prescribe pain medication in sufficiently high doses to treat their patients. The result is that many Americans live with chronic untreated pain."
The first witness was DEA Deputy Assistant Administrator for the Office of Diversion Control Joseph Rannazzisi, who immediately took issue with the notion that the DEA was trying to regulate medicine. "The title of this hearing, 'DEA's Regulation of Medicine,' is inaccurate," he complained. "DEA does not regulate medicine or the practice of medicine. DEA does investigate violations of the Controlled Substances Act, regardless of the source of the violation, be it a Colombian cocaine dealer, a marijuana trafficker or a doctor who abuses the authority to dispense controlled substances."
Saying that DEA considered the diversion of prescription drugs one of its most significant challenges, Rannazzissi said "small numbers of unscrupulous doctors" were part of the problem. Still, he said, the agency wasn't targeting doctors. "Generally speaking, in any given year, DEA arrests less than 0.01 percent of the 750,000 doctors registered with DEA for a criminal violation. More often than not, those violations are egregious in nature and are acts clearly outside the usual course of accepted medical standards."
That brought a sharp retort from the Pain Relief Network's Reynolds, whose life-partner, Sean Greenwood was a former Hurwitz patient who died last year as the family crisscrossed the country searching for a doctor who would treat his chronic pain, during her subsequent testimony. "The DEA contends that they only prosecute 0.01 percent of registrants," she said. "However, that's a misleading figure, because a very small number of registrants prescribe opioid medicines and an even smaller number would prescribe in doses that would relieve serious pain."
"So the actual number of doctors who are arrested is far greater, when you look at the correct denominator, which this leads me to my next point, which I think is really the most important point," Reynolds continued. "This is a government agency that plays fast and loose with the facts, uses incredibly inflammatory rhetoric, talks about crime and addiction and dependence and puts them all together and maybe has no cognizance of the fact that this all ultimately falls on and stigmatizes very, very sick people. But that is in fact what happens."
When it came his turn to testify, Flannery, a former prosecutor and congressional staffer and author of "Pain in America -- And How the Government Makes It Worse," took issue with Rannazzisi's taking issue with the hearing's title. "The title of the hearing, which is the regulation of medicine by DEA is, unfortunately, an apt one," Flannery retorted. "DEA has been regulating medicine, and for them to come here and say that they don't know it means that they either are consciously doing it or recklessly doing it. And I can't believe they're doing it recklessly, because we see the quality of people who work at the department. And that means there's an ideological purpose in regulating medicine. They do not approve of certain medical practices. And, if that is it, they should bring it to the Congress and tell us why, with statistics and explanations, because then it should be a formal policy rather than the secret one that it is presently."
Flannery accused DEA and the Justice Department of "bait and switch" tactics. The legal standard for criminal prosecution of doctors is that they have to be acting outside the course of professional medicine with the intent to push drugs, not treat patients, Flannery noted. "They create these standards on a case-by-case basis," Flannery said. "And how do they do that? They bring a doctor into the courtroom that they pay, who travels around the country, and the standard is created on a case-by-case basis by the DEA doctor."
Determinations of what constitutes criminal conduct by doctors -- as opposed to simple malpractice -- are better left to state medical boards, Flannery said under sympathetic questioning from Rep. Scott.
Ranking minority member Rep. Randy Forbes (R-VA) carried water for the Bush administration, asking whether marijuana should be legalized, worrying about teen prescription drug overdoses and "pharma parties," and asking about marijuana growing in national forests, while Rep. Louie Gohmert (R-TX) provided inadvertent comic relief. Gohmert wandered into the hearing room, announced that voters in his district didn't support marijuana legalization, then launched into a bizarre tale about a bag of sterilized marijuana seeds from which some seedlings sprouted he had seen in a court case once before retreating back into silence.
While last week's hearing marked the first oversight of the DEA's regulation of medicine in more than a decade, it wasn't enough, Reynolds told the Chronicle. "Although I submitted written testimony, we were limited to five minutes, so I spent my time basically explaining how offended I was at the farcical nature of the DEA and ONDCP testimony, denying the possibility of a chilling effect on physicians."
"This is a step on a slow journey toward enlightenment," Flannery told the Chronicle. "In Jerrold Nadler and Bobby Scott, you can't find two better lawyers who are sensitive to these issues, but the Congress is immersed in lots of other business, and it takes a lot to move members from their preconceived notions of what the drug war is about. Very few understand this is about the government invading medicine -- not prosecuting drug dealers. We will have to turn around an ocean liner in order to get action."
But hearings like last week's are a first step. "I've asked for more hearings, but I'm not getting the impression that's the next step," said Reynolds, who was invited to testify by Rep. Nadler. "What I've been told is that we need to educate the Congress. We've been doing that, but there seem to be a lot of closed ears on this issue. Still, more and more, there is some awareness that this is a terrible problem."
Reynolds added that she and others are working with the committee to seek legislation that would ease the DEA pressure on pain doctors. "Both Nadler and Bobby Scott showed real concern and came up afterward and asked what they can do."
Nadler spokesman Shin Inouye told the Chronicle Thursday that Nadler is looking into the matter. "He's very interested in the issue, but I haven't heard anything specific about new legislation yet," Inouye said.
There is a long way to go before America's estimated 40 to 70 million chronic pain patients and the doctors who seek to treat them can live without the fear of the DEA, but last week's hearing was a good -- if insufficient -- beginning, and lays the groundwork for further action.
The written testimony of all witnesses at the hearing is available online here.
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redditFrom An Empathetic Vet
Comment posted by Anonymous on Fri, 07/20/2007 - 2:59pmKevin,
I joined the Navy in 1977 and was honorably discharged 4 yrs. later. As a petty officer Boastwains Mate I can completely relate to the culture of alcohol abuse... and as a young lad of 18 I dove right into this bizarre culture. Being a good hard drinker seemed part of the job description... and thanks to my german genes I could drink like a fish! While many were blacking out... I was just hitting my stride!
Years later as an officer in the Merchant Marines I again routinely witnessed the ill effects of alcohol abuse. From drunkin captains not being able to get their ships underway to transitting very restricted waterways in Canada & Alaska while seriously impaired. I saw this abuse culminate with the infamous Exxon Valdez oil spill in Alaska.
Illegal marijuana prohibition is largely a byproduct of Western Christian Society... which of course is not based on truth but on the depths of willful delusion.
Alcohol = Pain (headaches, dead brain cells, bar tab, etc...)
Pain = Redemption (and you can't get into heaven w/o it)
Marijuana on the other hand is relatively benign and there's nothing God & Country hates more than something natural & benign... because then God & Country would be out of jobs... having lost their sick appeal & influence.
Lastly, we must take into consideration the huge special interest groups that pay for our representative Gov't... namely pharma companies who hate natural drugs that they can not patent for profit... especially an affordable hearty plant whose main side affect seems to be happiness!
My Libertarian perspective (pro choice on everything) tells me we should insist our representaitive gov't start acting in a legal and lawful manner as described in our Constitution... or remove the criminals as is required by law!
My tolerance for the dictates of the mentally & criminally insane waned long ago!
Billy B Blunt
P.S. "Fear of meaninglessness leads those who are weak in spirit, weak in will, to cling to religion for salvation... religion inverts the love of the earth into hatred of the earthly... Christianity is Platonism for the people" Nietzsche
Drug Policy Reforms is About Power
Comment posted by Anonymous on Fri, 07/20/2007 - 1:38pmIndividuals can buy tobacco, alcohol (in many degrees of potency), household cleaners that are poisonous (with no age restriction), all of the fatty food that one wants, and MANY weapons and dangerous objects, yet we cannot be trusted to make informed decisions about certain plants and chemicals.
The following are the entrenched powers that benefit from the (violent/oppressive) legal control of access to certain substances; in order to change policy, you have to call them out:
- Alcohol distributors
- Tobacco distributors
- Firearms distributors
- Pharmaceutical companies
- Pharmacists
- Doctors
- Insurance companies
- Organized crime groups, Terrorists, gangs
- DEA, ONDCP
- Police drug task forces
- Border Patrol Officers
- Coast Guard
- Prison Guards
- Elected officials who receive campaign contributions from any of the above
Including doctors on your list!
Comment posted by Anonymous on Mon, 07/23/2007 - 9:14amYou made a generalization that might hurt some peoples' feelings. I am a physician who is no longer practicing, because I chose to be compassionate and properly treat chronic pain patients. Not all doctors are into their six figure incomes! I had not had one for years! The money is not the reward, for all physicians.
But, your list could be indicative when it comes to ignorant physicians, both in practice and on the state medical boards. They are definitely in the "controlling" category! They don't want to keep up with the science of medicine! They just want to maintain the status quot. The VA is certainly not caring for their our soldiers' chronic pain! I cared for a few, who could not get their chronic pain treated at the VA!
The other problem with drugs is the corruption it brings, with many of the participants being caught with their hands in drug traffic, being those on the list above. I saw a recent video on you tube talking about CIA involvement and the Arkansas connection. You should look it up!
I had a family doctor in CA. who saved me until I came to FL.
Comment posted by Anonymous on Mon, 02/18/2008 - 12:23pmI had a very caring Dotor in Califonia and I had to move back to FL. and I can not wait to get out of this nightmare. I was on 125mcg of Fentanyl every 48hrs instead of 72hrs and Hydrocodone for breakthrough pain. He gave me my life back after such a long time. I believe it is horrible that they put Dotors in jail for helping people with true pain, instead they should get all agencies off there back and make Dotors treat pain suffers, are be punised. No Doctor should go straight to jail, maybe a fine the 1st time, the seconed time revoke for maybe 6months to a year with anothere fine and then jail. I believe as bad as we need good Doctors we should give them a chance to be redeemed then I am sure most all Doctors would make that change to stay out of jail. First of all the DEA, FDA, AMA and any other agencies need to get off there back and let them do there job in treating pain victems. I have suffered so much and so bad I am suprised I have not killed myself with to hips that need to be replaced and a very screwed up back that is the better part of my pain and I have had to use Nubain to keep my sanity even though I hate needles. I got a wonderful idea lets break a couple arms are legs off all the people that are against you and the patients and not let them get fixed or have anything, but Tylenol and I bet there would be some change. If you have alot of money you can find a way to get help if you are a pain sufferer and if you are broke you are screwed. This makes me ashamed of my own country, it's just sicking and I have considered leaving the U.S., because to them every one is an addict and with severe pain you well not feel ephoria just relief if taking as prescribed and not way under prescribeing like most do if they help you at all. I wish you all the best Doc you are the kind of Doctor we all need and others should look up to with respect. William .
Written Testimony
Comment posted by Anonymous on Fri, 07/20/2007 - 2:49pmIt seems that the link above to the written testimony only leads to a summary page of the hearing. Where is the testimony itself? I haven't been able to find it... for some reason.
You have to click on the
Comment posted by Anonymous on Fri, 07/20/2007 - 2:52pmYou have to click on the witness names.
Medical Marijuana
Comment posted by Anonymous on Fri, 07/20/2007 - 7:52pmWhy can doctors prescribe codene or morphine, which are more addictive than marijuana, but not marijuana.
Why can all doctors prescribe opiates and not marijuana?
Comment posted by Anonymous on Sat, 07/21/2007 - 2:10pmThat sure is a good question.
prescribing MJ
Comment posted by Anonymous on Mon, 07/23/2007 - 9:21amThey can prescribe MJ in some states!
The reason that many doctors won't, even in these states, is because they are being watched, doggedly, buy the DEA. The cops are telling your doctors, how to practice medicine. They also tell them how much of the controlled medications they can use. All without knowing, one darned thing about pain managment, or just medicine in general. And, if the docs won't listen, they end up with life sentences! Just look it up on our chronic pain mission(cpmission.com)!
Medical Marijuana
Comment posted by Anonymous on Thu, 07/26/2007 - 9:35amDoctors can prescribe coedine or morphine, which are more addictive than marijuana, because coedine and morphine are classified differently than marijuana under federal law (see http://en.wikipedia.org/wiki/Controlled_Substances_Act for more information). Coedine is classified as Schedule II, III or IV depending on formulation and morphine is classified as Schedule II, whereas marijuana is classified as Schedule I (no accepted medical use).
In some states, such as California, doctors may *recommend* the use of marijuana to their patients, but they still cannot *prescribe* it. It's a small but important technicality of the law.
? Where can you find out
Comment posted by Anonymous on Sat, 07/21/2007 - 11:34pmInformation on where to file a complain against a MD prescribing prescriptions without regards to the addiction? Long storty short my husband was released from a 30 involuntary commitment to detox his doctor was informed less than 24hrs out he was already given a script for percocets. Actually even offered him oxycontin!! Help!
IGNORANCE IS BLISS
Comment posted by Anonymous on Mon, 07/23/2007 - 9:45amI think most pain doctors would be afraid to write for anyone just coming out of detox. That is, if the patient told the doctor! Don't assume that the hospital is going to tell, the patients primary care or specialist physicians, that they have been detoxed. It could be against the wonderful HIPPA laws!
I think one might look into the fact that it was an involuntary comittment. I had many pain patients, whose families were well informed, that knew some behavior was not addiction. If a real pain patient gets meds, his life is improved. If a patient is just taking to meds to get high, then he needs his butt kicked out! They are the ones that cause doctors to lose their abilty to care for the patients, really having pain! I had no sympathy for them. And, many patients were dumped for unacceptable behavior. But, just remember, there are many other circumstances surrounding the patient. If a doctor knew a patient had chronic pain and refused to treat it, they could get in trouble, too! They have been sued and disciplined by medical boards for inadequate pain care! We doctors are stuck between a rock and a hard place. It is made even harder by people who do not understand what medical care is being supplied. HAS ANYONE EVER GONE TO THE DOCTOR'S APPOINTMENTS WITH HIM?
And if the doctor is informed and still giving out the meds, the medical board in the state can decide whether or not the treatment is correct. Remember the Hurowitz case? The medical board did not take his license because he was practicing within acceptable medical standards. Those standards are argued by the experts. That results in the DEA telling doctors how to practice medicine, with the games they play in federal courts!! So the cops know more than the doctors, with years of education!! Courts are nowhere to be deciding who should and should not get certain types of medical care!
One must realize the difference between taking pain medication every day and developing tolerance and physical dependence. That does not indicate addiction, per se. Addiction is a complex problem that includes craving and continued use, in spite of negative consequences. If the person has chronic pain, I guess we could offer them a bullett! Most would tell you it is better than living in severe chronic intractable pain 24/7!
Ignorance?
Comment posted by Anonymous on Mon, 07/30/2007 - 11:35pmThe doctor was informed this man is a 20 year addict to pain meds. AS I WRITE THIS HE HAS TAKEN 20 PERCOCETS TODAY from yet another script.
My brother in law also was a recovering addict spending the last 10 years mostly clean until he was written a script for Oxycontin his old habits quickly returned the night before he was to enter detox that he had chosen to go too he died in his sleep. He left behind 3 children 1 that he actually had custody of and was only 2 years old.
I GO TO EVERY APPOINTMENT WITH MY HUSBAND THE DOCTOR IS FULLY AWARE OF THE OVERDOSES, THE MISS USE.
I did just file a complaint with the state complaint department.
I disagree chronic pain patients who are addicts that have proven time again they are MED SEEKING the MD's should listen to the families...if not the families in my case the ER visits and NARCAN doses from the repeated overdose. Pain management I think not.
The is fully aware of his liver function decline he continues to insist Ultracet with Percocets isn't to much. I suggested Methadone figuring that has pain management benefits and he would have to go a clinic to get it...his doctor offered to write a script.
PAIN CLINIC DISCHARGED HIM BECAUSE HE REFUSED ANY TREATMENT THEY OFFERED BECAUSE HE SAID HE DIDN'T NEED IT.
He was clean for over 13 months his life was good. He functioned he had hope, he was active now he is none of the above.
Addiction is a complex problem that includes craving and continued use, in spite of negative consequences.
He lost his family, his children, his first wife, his buisness, his home, license, his health and his independance. He had pancreatitis at just 31 years old leaveing him a brittle diabetic.
Apparently this is the wrong blog to write on I understand doctors need to treat pain complaints. I have lupus when I complain of pain i have never been offered a narcotic nor am I a dx'd opiate addict.
Playing Dr. ?
Comment posted by Anonymous on Sun, 07/22/2007 - 9:31amIam sure most if not all smart and educated people if they knew all the facts would find it so ridiculious that the DEA is using our tax $ to go after Dr. treating patients with chronic pain and making these patients suffer needlessly becasue of their biased opinion of how a Dr ,who has spent years in medicial school feels whats best for the patient into a crime ! I believe that in a truely free country that all adults would have access to whatever medication they feel they need to improve the quality of life for them ! The DEA needs to go back to school and learn what their real job is suppose to consist of ,and harassing Dr's and patients is certainy not listed as one of their job task ! With tons of illegal drugs crossing our borders on a daily basis ,all I can say is how dare they !
get educated?
Comment posted by Anonymous on Mon, 07/23/2007 - 9:49amI could not have said it any better! The drug war is a failure! And they go after the easiest targets they can find!
hemp
Comment posted by Anonymous on Sun, 07/22/2007 - 9:53pmhow much money does the cotten and timber industry spend lobbying (bribing) congres. hemp can make paper and cloth....
ignorance again?
Comment posted by Anonymous on Mon, 07/23/2007 - 10:05amAnyone who knows, industrial hemp is going to ruin any medicinal hemp if placed in the same field! They cross pollinate, so far as I have read, resulting in a useless form of the hemp--industrial hemp! Industrial hemp should be taken off of the drug list. This is just a power struggle with the DEA. Power hungry, are we? Why did they become cops?
Why, in the world, would a sensible society import something like hemp?!? The reasoning is not scientific! It seems to be driven, right now, by conservative Christians, like me! Except, they do not know any better!
The Bible says "my people perish for lack of knowledge" The use of wine in the bible shows that there is either arrogance and ignorance, among our brethren. Alcohol is not prohibited! Don't try to tell me it was grape juice! The word in my Greek Bible is translated alcoholic wine. It kept,while grape juice did not! INDUSTRIAL HEMP WILL NOT MAKE ANYONE HIGH!
Any smart and reasonable Christian should know that the hemp is completely useless for druggies! It is also, likely, 80% of what the DEA, and drug task force people, are pulling up, in its natural state (wild), in our national forests. Then they claim they are pulling up illegal drugs!!! It has been reported, before!
prison
Comment posted by Anonymous on Sun, 07/22/2007 - 10:03pmhow much money would be lost or cells emptyed if pot was legal in privit prisons..
how much money do they spend on congres
DEA
Comment posted by Anonymous on Sun, 07/22/2007 - 10:11pmare the DEA just hired thugs protecting underground proffets???
Hydrocodone
Comment posted by Anonymous on Wed, 01/02/2008 - 8:32pmAfter 4 years of controling my back and leg pain through the use of hydrocodone medication, always the same prescription (no increase), the only place I found that I could get it in a quantity that would help the pain has apparently been closed down by the government two or three months ago. I am now back to constant uncontrolabe pain. My younger brother had back pain also but he was talked into having sugery to correct the problem. After three surgeries, he cannot stand straight and cannot work, but he now has access to the same pain medication and quantity that I had been taking for 4 years. It appears that if you let a doctor carve you up and pay him thousands of dollars to fix you where you can't walk, stand, or work, you can finally get some pain relief but there is absolutely no quality of life left. He is slowly killing himself now with a combination of medication for the pain and alcohol for the loss of quality of life, which is legal. I don't understand this unless someone is making a lot of money off of this travesty or someone just loves the power of controlling peoples lives. I am 64 years old so I don't have a lot of time left anyway. I will commit suicide before I submit to this kind of abuse but it really sucks that this is the only two options one has with our present BIG BROTHER mentality. I pray that all of the government officials and their families die in horrible untreated pain.
.org
Medical Marijuana
Comment posted by Anonymous on Fri, 07/20/2007 - 12:34pmPersonnally, I'm a veteran. I suffered a Tramatic Brain Injury in "98". Please understand I've been Honarablely discharged since "77".
But I have found,relief from depression, sleep, anxity, constant headaches,and consetration in the use of Marijuana. Like an asprin for a headache(whitch causes liver damage by the way). Where as the medication that I was given me, from the V.A. (leagle drugs) for the same condistion had horiffic side effects, such as social function and interpersonnal relationships. Now the same goverment I served, well. Gave me plenty Alc. and tobacco. I know it was my dessision to do. I was only 17 at the time.(IMPRESSIONABLE AGE) Which has proven over and over again the damage it causes the body and in some cases, our fammilys. But their is no evidence of Marijuana having any damaging effects social or psycological. As do Tobacco or Alc.. But yet its leagle. HUMMMMMMMM ! Somethings wrong with that pitcher ? Insureance and medical care have been affected by thoses leagl drugs(alc.&tobacco).
Kevin
Alabama VETERAN