Under-treatment of Pain

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Feature: Prescription Drug "Fatal Medical Errors" Rising Dramatically -- What Does It Mean?

A study released this week charted a startling increase in deaths from "fatal medical errors," particularly those associated with people mixing street drugs and alcohol with prescription medications at home. In this context, "fatal medical error" refers to people dying from taking prescribed medications, usually opioids, but also including other drugs, such as benzodiazepines (Valium, for example).

the pain reliever Oxycontin
But while the numbers have some in the medical community calling for tighter restrictions on prescribing, they have some in the pain relief community worrying about just that possibility. And they're leaving other interested observers wondering just how accurate they are, what they mean, and just who is dying.

According to the study by University of California at San Diego sociologist David Phillips, which examined all US death certificates from the beginning of 1983 to the end of 2004, the overall death rate from fatal medical errors increased more than three-fold over that period, but the death rate from fatal medical errors when the drugs are taken at home and combined with alcohol and/or street drugs has increased a whopping 30-fold.

That means that accidental overdoses at home with alcohol or street drugs involved accounted for 17% of fatal medical error deaths in 2004. That's a seven-fold increase over the 2.3% reported in 1983.

In real numbers, the study found 22,770 fatalities from medication errors in 2004, with 3,792 of them attributed to mixing meds with alcohol or other drugs. In 1983, by contrast, only 92 people died from mixing drugs.

The increase in fatal medical errors involving prescription drugs is larger than the increase in the use of prescription drugs themselves, which has increased about 70% in the last decade.

Fatal medical errors involving prescription drugs dispensed in a hospital or doctor's office setting increased only 5%, while such errors involving home use but no street drug or alcohol use and such errors involving medical settings and alcohol and/or street drug use both increased five-fold.

Phillips and his coauthors pointed their finger at the ongoing migration of prescription drug dispensing from medical professionals at hospitals and doctors' office to patients at home. The decades-long shift in the location of medication consumption from clinical to domestic settings, they said, "is linked to a dramatic increase in fatal medication errors."

It is not just people swallowing prescription pills at home, but the involvement of other drugs in the overdoses that is disturbing, they said. "Domestic fatal medication errors, combined with alcohol and/or street drugs, have become an increasingly important health problem."

The study recommended increased screening for patient abuse of prescription drugs, alcohol, or street drugs, as well as increased vigilance toward prescribing medicines with known dangerous interactions with alcohol or street drugs.

But others in the medical profession are taking the study's findings and running with them. One medical blogger looking to restrict access to pain meds put it like this: "What is going on here is a direct result of politicizing medicine by the pain rights movement and the organizations that have mandated liberal pain management into guidelines and enforcement standards. More recently the push to promote patient satisfaction in healthcare organizations has resulted in liberalizing of prescribing opioid medications to make patients happy. Whatever happened to do no harm? Medicine has lost its way. These numbers should serve as a wake up call and re-examination of pain management practices."

And that is, unsurprisingly, raising hackles in the embattled pain relief movement. Pain relief advocates have long argued that access to effective opioid pain medications is too restricted, pointing to numerous cases of doctors prosecuted and imprisoned for their prescribing practices -- and the patients being left in the lurch.

"The pain relief movement had made only modest gains when it was faced with a government-wide crackdown, led by the Justice Department," said Siobhan Reynolds of the Pain Relief Network. "Now, those who know that they could find help in the form of opioids, find themselves shut out of care and stigmatized by the entire system. I don't think I have ever seen a more destructive phenomenon sweep this country... all in the name of a drug free America, an America which could never exist."

It's not pain patients who are dying of opioid overdoses, said California pain management physician Dr. Frank Fisher. "I've analyzed dozens of these deaths now, and the field of forensic pathology is in such disarray that any time they find an opioid post-mortem, they label the death an overdose," he said. "But pain patients almost never overdose because of the phenomenon of tolerance -- unless it's a massive deliberate overdose, and then they have to take the benzos, barbiturates, or alcohol."

"It's true that it's very hard for an opioid tolerant person to overdose -- if they know what they're doing," said Dr. Matt Das Gupta, an epidemiologist working with North Carolina's Project Lazarus, a program that distributes the opioid antagonist naloxone (Narcan) to drug users to prevent overdoses. But mixing opioids with other drugs or alcohol can fell even the hardiest opioid tolerant patient, he warned.

Most pain patients are dying of cardiac disease, said Fisher. "Heart disease kills pain patients because they're sedentary because of their conditions and they're under stress from chronic pain. What I'm seeing is an epidemic of cardiac disease brought on or exacerbated by chronic pain. Medical examiners are calling them overdoses because they have opioids in their systems, but the medical examiners are wrong when it comes to chronic pain patients."

Suicides among pain patients are no surprise, said Fisher, but they tend to be undercounted. "Unless they leave a note, the medical examiner never calls it suicide, they will call it undetermined or accidental overdose. The medical examiners are giving us terrible data," he complained.

"Medical examiners not coding properly is a perennial problem," said Das Gupta. But that could go both ways. "There are people who died who probably should be included, but were not coded as ODs. For example, one code is chronic use of opioids. If you include that, the numbers go up by 10% or 15%."

(For more on the controversies surrounding drug-related deaths, cause of death coding issues, and associated topics, check out this page at Brian C. Bennett's web site, Truth: The Anti-Drug War.)

While pain relief advocates such as Reynolds and Fisher are concerned primarily with protecting patients' access to effective opioid pain relievers, harm reductionists such as Das Gupta are concerned primarily with preventing overdoses and other deaths related to drug use. While the harm reduction movement has traditionally focused on the use of street drugs, like cocaine and heroin, the rapid increase in prescription drug deaths may be a sign that it needs to broaden its focus.

"When you look at deaths at the state level and start to pull actual medical examiner case files, you find that the people dying are really a mix of pain patients, non-medical opioid users, and heroin users," said Das Gupta. "Here in North Carolina, we found that 80% of prescription overdose deaths were people with prescriptions. That doesn't mean they were chronic pain patients, though; they could have been people scamming docs. What we have is a really heterogenous mix, and the way things are coded doesn't offer enough nuance."

Project Lazarus is trying to adjust, he said. "We've been tweaking traditional programs to a different setting. Instead of using needle exchange programs, we're doing it through doctors' offices," explained Das Gupta. "Anyone who prescribes opioids for pain in North Carolina should be considering naloxone for specific populations," he said. "There is an ethical responsibility for physicians not to endanger their patients' lives."

"We're working on overdose prevention here in New York, but the people we have had access to are the heroin users," said Dr. Sharon Stancliff, medical director for the Harm Reduction Coalition, for whom she oversees drug overdose prevention projects in New York and San Francisco. "But the bigger problem is people misusing or abusing opioids. We need to be getting information out to the general practitioners who are prescribing these drugs. They need to be prescribing Narcan with all those meds," she suggested.

"We need to change the national agenda about overdose prevention," said Stancliff. "Naloxone is an answer, but it's not the only answer. We need naloxone, we need education, we need more research."

And, Stancliff added, the federal government needs to quit being an obstacle and start helping to solve the problem. "We don't have an early alert system, we have really bad surveillance, we're not getting the research done," Stancliff complained. "We don't know who is dying -- is it the people being prescribed the drugs? Is it people they're giving them to? Is it illicit drug users? We don't know enough. The Centers for Disease Control don't quite cover this, and it should be a Substance Abuse and Mental Health Services Administration (SAMHSA) issue, too. Maybe in the next administration, when harm reduction isn't a dirty word."

Pain Medicine: Pain Relief Network Sues State of Washington Over Narcotic Prescribing Guidelines

The Pain Relief Network (PRN), a nonprofit organization waging a lonely battle to protect the rights of doctors who prescribe opioid pain relievers and patients who receive them, has filed a lawsuit against the state of Washington over prescribing guidelines promulgated in March 2007 by the state Department of Health.

The guidelines are designed to guide physicians through the minefields of narcotic prescribing in a time where they face a rising clamor for the relief of pain at the same time they face the threat of arrest and prosecution by federal or state agents intent on stopping narcotic drug abuse. But PRN alleges that Washington's guidelines deter doctors from prescribing opiates and have had an undue negative influence on prescribing practices across the country.

The guidelines, which only apply to the treatment of chronic pain -- not cancer pain, acute pain or hospice care -- recommend that daily opioid doses not exceed 120 milligrams of morphine or the equivalent if both pain and physical function are not improving. PRN argues that the guidelines are inflexible and fail to account for the needs of real patients.

According to the complaint filed late last month on behalf of a Washington state doctor and a group of Washington state pain patients, plaintiffs seek an injunction blocking the guidelines from being used. The complaint argues that the Washington guidelines violate both state laws and federal civil rights laws.

Pain Relief Network Sues State of WA

As always, we ask that you help PRN fight to protect the rights of patients and the doctors who treat them. Please click the link below.


Pain Treatment Advocacy Group Sues State of WA

Jun 25, 2008

By: Donna Gordon Blankinship

The Associated Press SEATTLE - A pain treatment advocacy group filed suit Wednesday in federal court to challenge the restrictions Washington state officials have put on prescription pain medication.

The nonprofit Pain Relief Network says the guidelines for prescribing narcotics, written by the Washington state Department of Health and published in March 2007, have influenced pain treatment across the country and have made doctors afraid to give opiate prescriptions[...]

Complaint for Declaratory and Injunctive Relief, Damages a class action lawsuit by Laura Cooper (lead attorney) et al., Filed: 2008-06-24

Exhibit 1: The WA state Opioid Dosing "Guidelines" by Agency Medical Directors Group (AMDG); Mar. 2007; Filed 2008-06-24

Exhibit 2: Findings of Fact Laura Cooper, Esq.; Filed 2008-06-24 www.painreliefnetwork.org

United States

Pain Medicine: Kansas Doctor Fights Back, Attacks Federal Prosecution and Controlled Substances Act as Unconstitutional

Lawyers for a Haysville, Kansas, physician facing a 34-count federal indictment alleging he acted as a drug dealer in prescribing pain medications fought back last Friday, filing in federal court a motion to dismiss both the indictment and federal Controlled Substances act (CSA) as unconstitutional. Attorneys for Dr. Steven Schneider argued that federal prosecutors in Wichita improperly claimed authority over the regulation of medicine.

Schneider and his wife, a nurse at his Haysville clinic, were arrested in December amidst great fanfare from prosecutors, who referred to the general care, ambulatory, and pain relief clinic as a "pill mill" and asserted Schneider was "linked" to 56 deaths. They remained in jail held without bond until last month, when they were finally released pending trial.

Schneider is only the latest of dozens of physicians arrested and tried by federal prosecutors over their pain medication prescribing practices in recent years. With the DEA and Justice Department prosecutors asserting that they know best medical practices and willing to arrest doctors whose practices they disagree with, the field of pain relief medicine has been plagued by the tension between the imperatives of pain relief and those of drug control.

Schneider and his lawyers want the government out of the doctor's office. "This case is an effort by the federal government to define and regulate the practice of medicine masquerading as a criminal prosecution," wrote Schneider's legal team, which includes nationally known specialists. "This case should not be about whether Dr. Schneider fell short of the standard of care for certain patients, but whether he engaged in the legitimate practice of medicine."

Schneider's medical conduct should be a matter for the state medical board, not the federal criminal apparatus, the lawyers wrote. "All of the accusations against Dr. Schneider and Ms. Atterbury [Mrs. Schneider] revolve around matters of medical science, professional judgment, and evolving standards of practice. However, by seizing on widespread ignorance and hysteria surrounding the use of opioid analgesics in the treatment of chronic pain, the government has endeavored to shoehorn these matters, which bear no relevance to criminal culpability, into the rubric of drug dealing and health care fraud. With regard to the charges related to the Controlled Substance Act ('CSA'), the sole question should be whether Dr. Schneider was a drug dealer 'as conventionally understood.' Instead, the government confounds this question with irrelevant facts and improper standards."

The CSA is unconstitutional on its face as "impermissibly vague" when it comes to providing guidance for physicians and as applied in this particular indictment, the lawyers argued. "As applied in the Indictment, the CSA fails to adequately and meaningfully inform physicians of what conduct is proscribed, largely because such conduct is arbitrarily and unilaterally determined by enforcement authorities lacking knowledge and expertise with respect to issues of medical science and ethics."

No word yet on when a ruling on the motion is expected. But the direct attack by the federal government's drug war apparatchiks on pain doctors and the patients they serve has now provoked a counterattack aimed right at the drug war's jugular vein.

The Pain Relief Network: Update 5-19-08 -- Schneider Defense Calls DOJ Prosecution Unconstitutional

Schneider Defense Calls DOJ Prosecution Unconstitutional: Read the Briefs


As always, we ask that you help PRN fight to protect the rights of patients and the doctors who treat them. Please click the link below.


Schneider defense calls DOJ prosecution Unconstitutional

This case is an effort by the federal government to define and regulate the practice of medicine masquarading as a criminal prosecution. This case should not be about whether Dr. Schneider fell short of the standard of care for certain patients, but whether he engaged in the legitimate practice of medicine [...]

Memorandum of points and authorities in support of the defendants' joint motion for absention

The federal government has usurped the authority of the State of Kansas to regulate medicine within the State by bringing a halt to its regulatory process, and assuming that authority, impermissibly, through the federal criminal process. If any part of the Indictment is not dismissed as unconstitutional or otherwise defective, this Court should abstain, allowing the State process to run its course [...]

Competetive Enterprise Institute Joins Pain Relief Network in the battle against untreated pain

May 16, 2008
Cei.orgToday, millions of Americans live in chronic pain, without adequate access to prescription pain medications, because their doctors are too afraid of being harassed or even arrested by the Drug Enforcement Administration to prescribe sufficient doses. Everyone agrees that doctors should not be using their positions to supply addicts with narcotics or feed the illicit drug market. Many doctors, however, have been arrested or threatened with loss of their medical licenses simply for prescribing opiate-based pain medications in doses that federal drug authorities believe are too high [...]


Doctor fights prosecutors' efforts to gag him, supporters

Wichita, KS
United States
Fort Mill Times (SC)

Pain Treatment: Prosecutors in Case Seek to Shut Up Doctor, Critics

Federal prosecutors in the case of Haysville, Kansas, physician Dr. Steven Schneider and his wife, who were indicted for allegedly operating a "pill mill" by prescribing to pain patients, asked a federal judge last Friday for a gag order to keep Schneider and his supporters from making their case in the court of public opinion.

The case of the Schneiders has attracted the attention of pain treatment advocates critical of heavy-handed federal government attacks on pain doctors, including the Pain Relief Network. The network's leader, Siobhan Reynolds, has been instrumental in mobilizing Schneider's patients in support of their doctor and in opposition to the federal prosecution. Prosecutors sought a temporary injunction to bar Schneider, his wife, other family members, and PRN's Reynolds from talking to the media.

"We strongly oppose a gag order because we believe in the public's access to the justice system," defense attorney Lawrence Williamson told the court. "We think the request is overbroad and not supported by law at all." While prosecutors accused the defense of trying to taint the jury pool, Williamson said that was not the case. "We are often contacted by media to respond to allegations that are made by the government and if the public has questions to the allegations we should be able to respond to those within the rule," Williamson said.

Prosecutors had no problem with media coverage of the case when they trumpeted the arrests of Schneider and his wife back in December, and they remained quiet when local media ran stories supportive of the prosecution. But questions raised in the press by Reynolds and other supporters about the 34-count indictment of Schneider accusing him of a variety of crimes related to his prescribing of opioid pain medications have the feds seeking to silence their foes.

Prosecutors claimed Reynolds told a patient that if he was going to kill himself because of lack of access to pain medications, he should do it publicly -- a charge Reynolds angrily rejected, calling it "absolutely false."

"This is just a wild allegation," Reynolds said. "Basically it was put out there to try to smear me. The Pain Relief Network works very hard to try to stop the suicides going on across the country because of untreated pain, the epidemic of untreated pain," she told the Associated Press. "I'm shocked that the government would try to get a gag order against a political activist. I find that stunning."

Pain Treatment: INCB Calls for Greater Access to Opioid Medicines in Developing World

As part of its 2007 Annual Report, released Wednesday, the International Narcotics Control Board (INCB) issued a press release saying that "ensuring access to pain treatment medicines is vital and possible." Millions of people around the world are suffering chronic and acute pain because narcotic pain medications are not being sufficiently used, the group said.

The INCB is a 23-member independent commission that works with the UN Office on Drugs and Crime (UNODC), its Commission on Narcotic Drugs (CND) and other international organizations to monitor implementation of the series of international treaties that form the legal backbone of the global prohibition regime. While its remit includes ensuring adequate supplies of drugs are available for medical and scientific uses, it spends most of its resources trying to prevent any deviations from the global prohibitionist drug policy status quo. (See related story here.)

According to the INCB, while global consumption of opioid pain relievers has more than doubled in the past decade, the vast majority of that growth has occurred in Europe and North America, which together accounted for 89% of global morphine consumption in 2006. By contrast, the 80% of the global population that lives in developing countries consumed only 6% of the morphine supply. In some countries, access to morphine is "extremely low and almost non-existent for most of the population," the group said.

The situation is similar for some other opioids such as fentanyl and oxycodone. In 2006, Europe and North America accounted for 96% of global fentanyl consumption and 97% of oxycodone, the group reported.

The lack of sufficient access to these powerful pain medications is "due to diverse interrelated factors such as inadequate medical education of health professionals and lack of knowledge and skills in pain treatment, public attitude, regulatory impediments or economic constraints," the INCB said. In a slap at proposals to deal with Afghan opium production by licensing it and diverting it into the legal medicinal market, as the Senlis Council has suggested, the INCB said global supply was at high levels and not the problem.

"Suggestions to further increase the supply of raw materials by using opium from the illicit production in Afghanistan do not address the cause of the problem. Governments should focus on measures to increase demand for pain-relief medication in line with the recommendations of INCB and WHO," said INCB President Philip Emafo.

The INCB said it urged governments to identify obstacles to adequate access to narcotic pain medications and to take steps to improve their availability. It also announced that, in consultation with the World Health Organization (WHO), it had created the Access to Controlled Medications Program to address identified impediments. The group urged all governmental and concerned international organizations to cooperate with the WHO, and called on governments to pony up some cash to pay for it.

Pain Wars in the Heartland: With Their Doctor Behind Bars, Kansas Patients Wonder Where To Turn

In a drama that has been played out all too many times across the country in recent years, the Justice Department's campaign against prescription drug abuse -- if you can call it that -- came in crushing fashion to Haysville, Kansas, last month. Now, a popular pain management physician and his nurse wife are being held without bond and more than a thousand patients at his clinic are without a doctor, but the US Attorney and the Kansas Board of Healing Arts say they are protecting the public health.

It all started December 20, when federal agents arrested Dr. Stephen Schneider, operator of the Schneider Medical Clinic, and his wife and business manager, Linda, on a 34-count indictment charging them with operating a "pill mill" at their clinic. The indictment charges that Schneider and his assistants "unlawfully" wrote prescriptions for narcotic pain relievers, that at least 56 of Schneiders' patients died of drug overdoses between 2002 and 2007, and that Schneider and his assistants prescribed pain relievers "outside the course of usual medical practice and not for legitimate medical purpose."

In their press release announcing the arrests, federal prosecutors also said that four patients died "as a direct result of Schneider's actions," but the indictment does not charge Schneider or anyone else with murder, manslaughter, or negligent homicide. In all four deaths, the patients died of drug overdoses, with prosecutors claiming Schneider ignored signs they were becoming addicted to the drugs or abusing them.

A handful of Schneider's former patients have filed malpractice lawsuits, claiming they became addicted as a result of his treatments. The Kansas Board of Healing Arts was investigating several complaints against Schneider before it backed off at the beginning of 2007 at the request of federal prosecutors seeking to build their case. (The US Attorney's office in Wichita denies that it asked the board to desist, but the board insists that is in fact the case.)

Under pressure from state legislators, the board acted this week, suspending Schneider's license to practice and effectively shutting down his clinic, which had remained open with physicians' assistants writing prescriptions. That move came as a surprise to Schneider's patients and supporters, who had been engaged in negotiations with the board to keep the clinic open.

But if federal prosecutors, the state board and a few patients are painting Schneider as a Dr. Feelgood, for some of his patients, he was a life-send. Debbie Sauers was one of those patients. Suffering from the after-effects of a dissecting aortic aneurysm and chronic pain from four failed back surgeries, the former nurse said she now has nowhere to go. "The clinic is shut as of tomorrow, and today was the last day to get prescriptions filled," she said Wednesday. "Dr. Schneider was the only one who would treat me with pain medicine, and now I don't know what I'm going to do," she said.

Her efforts to find another doctor to take her on have been a stark exemplar of the stigmatization faced by pain patients whose physician is accused of being a pill-pusher. "I've had doctors' offices refuse to see me or laugh in my face or tell me to check into drug rehab when I tell them I was one of Dr. Schneider's patients," she said. "If you go to the ER, they hand you a list of drug rehab places. They put my doctor in jail, and no one will treat me now." Sauers is currently on massive doses of morphine and high-dose Lortab and says her cardiologist tells her a rapid withdrawal could kill her. "I don't know what to do," she repeated.

Darren Baker is another patient who swears by Dr. Schneider. The operator of a tree gardening service, Baker has bone spurs in his knees from years of climbing, and two years ago, he fell out of a tree, shattering both his heels. "They put all kinds of hardware in my heels, and I have to have pain medications just to walk," he said. "With the pain meds, I can't walk real well, but without them, I can't walk, period. Dr. Schneider was the only one who would treat me."

Now, like Sauers, Baker is in search of a doctor. "I haven't found one yet," he said. "I got a list today, but most of them are turning you away if you're associated with Dr. Schneider. If I can't get another doctor, I won't have any option except to retire and go on disability. I take my medicine to be a productive member of society," he said angrily. "I need my meds to survive and pay my bills and fight the daily grind. This really goes against our constitutional rights. How the hell can I pursue happiness lying in bed?"

If convicted, the Schneiders face a minimum of 20 years in federal prison, and given the multitude of counts, they could theoretically face centuries. While, since their arrests, they have been excoriated in the Kansas press and by politicians, they have also received strong support, not only from patients, but also from a national pain advocacy organization, the Pain Relief Network. Headed by Siobhan Reynolds, a former documentary film maker turned crusader after her life partner suffered horrendously from lack of adequate pain treatment before dying in 2006, the network has done highly effective advocacy on cases ranging from that of imprisoned Northern Virginia pain specialist Dr. William Hurwitz to wheelchair-bound, formerly imprisoned, and now pardoned Florida pain patient Richard Paey.

Reynolds senses a similar injustice on the Kansas prairies. "Dr. Schneider is a wonderful doctor and he ran a wonderful clinic," she said. "But the Justice Department comes in here and after the fact characterizes his medical practice as drug dealing and also after the fact decides that a patient death is caused not by a doctor but by a 'drug dealer,' making it now tantamount to murder, with a 20-year mandatory minimum. If anyone wonders why doctors don't take care of sick people, this is why."

The root of the problem, said Reynolds, is the Controlled Substances Act, under which the Justice Department determines what constitutes proper medical practice and what doesn't. "Under the act, the exchange of money for drugs is presumptively illegal, and doctors have to show they are doing medicine in an 'authorized fashion' approved by the Justice Department. Under the act, doctors are effectively presumed guilty until proven innocent. It's backwards, and it helps explain why it is so difficult to win these cases," she said.

The Pain Relief Network will shortly bring a federal lawsuit challenging the Controlled Substance Act, Reynolds said. "The act is profoundly unconstitutional and unlawful. It reverses the presumption of innocence, and we think we can win that challenge, even if we have to go to the Supreme Court."

While the network had vowed to file the lawsuit last month, it hasn't happened yet. That's because the network has been too busy putting out fires in Kansas, she said, adding that the lawsuit will be filed soon.

Meanwhile, Dr. Schneider and his wife remain jailed without bond at the request of federal prosecutors pending a first court date later this month. His patients are now scrambling to find replacement doctors with little success, especially now that other local doctors see what could await them if they apply aggressive opioid pain management treatments. And a chill as cold as the February wind is settling in over pain treatment on the Kansas plains.

Perhaps Dr. Schneider is guilty of failing to adequately screen his patients, said Darren Baker, but that's not a crime. "Pain meds are narcotics," he said. "Some people have to have them to survive, but other people just want them. I think Dr. Schneider should have covered his ass more. A drug addict is going to get his drugs, whether through a doctor or on the street. They can buffalo a doctor. But when they abuse their prescriptions, how can it be the doctor's fault? Maybe he could have done things differently, but he operated in good faith."

Pain Medicine: Advocacy Group to Challenge Controlled Substances Act In Lawsuit Aimed at Protecting Physicians, Patients

Haysville, Kansas, physician Dr. Stephen Schneider and his nurse wife, Linda Schneider, were arrested on a 34-count federal indictment last month for allegedly improperly prescribing opioid pain medications and causing the deaths of at least four patients. The Schneiders are only the latest pain management health care providers to fall victim to the federal government's war against prescription drug abuse and diversion, and now a leading pain relief advocacy group is vowing to take the government to court to block further harassment of physicians and the pain-ridden patients who rely on them.

Last Friday, the Pain Relief Network announced it will seek a civil injunction barring the Justice Department from prosecuting the Schneiders. But the lawsuit could have much broader implications than the couple's freedom. It will argue that the way the federal Controlled Substances Act is applied to doctors and patients is unconstitutional.

"I want a judge to take a look at this and see if the United States has authority to prosecute," Pain Relief Network head Siobhan Reynolds said during a press briefing last Friday. Reynolds cited a ruling in a similar case that such prosecutions give the government unrestrained power to interfere in the doctor-patient relationship.

The real victims of the government's crackdown on the Schneiders and other health care professionals prescribing opioid pain medications are patients, said Reynolds. "These patients are in real harm's way," Reynolds said. "They are being attacked by the Department of Justice."

While some of Dr. Schneider's former patients have filed malpractice lawsuits claiming they became addicted because of his prescribing, other patients said he had been a godsend and that they are suffering now without him.

One was Jamie McGuire, 49, who had been receiving pain meds for severe arthritis in his spine, hips, and shoulders resulting from an auto accident. Since Schneider was jailed, he has been unable to even get a referral to another doctor. "I think they railroaded him," he said of the prosecution. McGuire told reporters he is almost out of pain medication and his situation is dire. "If they don't do something, I will take myself out," McGuire said.

Another patient, Martin Beatty, 46, also showed up to support his doctor. He said he opted for a regime of pain meds rather than surgery or steroids after falling from a roof 12 years ago and had been a patient of Schneider's for three years. He admitted being dependent on his pain meds, but said that shouldn't matter. "Addiction doesn't mean I am going to be a bad person," Beatty said. Now he worries about going through withdrawal without being under a physician's care.

This week, patients and advocates continued to fight for Dr. Schneider, who, along with his wife, remains jailed. They gathered at his offices to show support and sign petitions, one to join the federal lawsuit, the other to keep the Kansas Board of Healing Arts from moving to suspend his license. According to Reynolds, the clinic will be forced to close because the physician assistants now writing prescriptions are doing so under the auspices of working for a clinic owned by a licensed physician. Other doctors who once practiced at the clinic have been run off by fears of federal prosecution, she said.

"Right now we are calling on the medical board to refrain from joining in this attack on this clinic. This clinic has been hobbled by the Justice Department. These patients are living in mortal fear," Reynolds said.

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