Last year, DRCNet reported on the saga of Dr. William Hurwitz, a Virginia physician who bucked the system by simply doing his duty in prescribing adequate quantities of narcotics to patients who needed them for pain. (See http://www.drcnet.org/guide10-96/pain.html, http://www.drcnet.org/rapid/1996/6-5-1.html and http://www.drcnet.org/rapid/1996/12-9-1.html.) In the aftermath of Hurwitz's license suspension, two of his patients committed suicide due to severe, untreated pain. One of them, retired police officer David Covillion, filmed a dramatic videotape the day before ending his life, describing in no uncertain terms the extremity of his pain and the insanity of the system -- state regulatory agencies and the DEA, and pervasive misconceptions about pain treatment within the medical profession itself -- that left him with no relief in site. An excerpt from Covillion's videotape was included in a Sixty Minutes report last year.
At long last, Dr. Hurwitz's approach to pain control has been officially vindicated by the state of Virginia. The Virginia Board of Medicine reinstated both his license to practice medicine and to prescribe controlled substances, and members of the board expressed their agreement with the fundamentals of his pain control methodology. The one remaining obstacle to Hurwitz's practice is the DEA.
In a significant turn of events, the Virginia Medical Society has issued guidelines to physicians calling for aggressive treatment of pain, stating that physicians can and should make use of narcotics (also known as opioids) when called for in treating pain, and should prescribe them in sufficient quantities to provide meaningful relief. The statement succinctly summed up the problem as follows:
"Inadequate understanding about issues such as addiction, tolerance, physical dependence, and abuse has led to unfounded stigma against proper opioid prescription. Fears of legal and regulatory sanctions or discipline from local, state, and federal authorities often result in inappropriate and inadequate treatment of chronic pain patients. Undertreatment or avoidance of appropriate opioid therapy increasingly has been reported by physicians, patients, and other health care team members."
Importantly, the document acknowledges the tolerance effect -- greater quantities of opioids are often needed over time to achieve the same level of relief -- and states that tolerance does not imply addiction.
This document will soon be available on the web site of the American Society for Action on Pain (ASAP), http://www.actiononpain.org, and many other documents related to pain control are on the site already. You can help educate doctors in your area by printing out these documents and distributing them.