David Borden, Executive Director, [email protected], 8/30/02
This week saw the sad news that Dr. William Hurwitz, a courageous northern Virginia doctor who dared to prescribe opioids (narcotics) to patients in severe, chronic pain based on their medical need, has decided to quit his practice at the end of this calendar year. Hurwitz has come under scrutiny more than once, and there is currently a federal investigation under way regarding his prescribing practices. The investigation was triggered by the fact that Dr. Hurwitz prescribes opioids to patients in severe, chronic pain based on their medical need.
Wait, you're asking, isn't that what every doctor does? Actually, no. Opioids are also used non-medically by recreational users and habitually by addicts, and there are large numbers of drug police throughout the country who make a living hunting down those non-medical users and their sellers. Unfortunately, precious few of the drug police have the faintest clue about medicine. Hence, they frequently perceive illegality where it doesn't exist.
Pain patients wind up in the crossfire and tend to wind up without proper treatment for their long-term, debilitating conditions. Doctors who, like Hurwitz, dare to do the right thing, wind up losing their prescribing licenses. Doctors and patients both sometimes end up in prison, sometimes for decades -- often for simple good medicine or reasonable behavior to be expected of any sufferer.
The result is a quiet but widespread and unnecessary national tragedy of serious under-treatment of agonizing pain. Police and prosecutors bear most of the blame. Their mindless and monstrous attacks on doctors and patients have chilled pain treatment nationwide. The word "monstrous" is not an exaggeration. There is currently a criminal case in process where a doctor and his nursing staff are being prosecuted on RICO charges because someone in law enforcement who is ignorant of medicine decided he could get away with it. RICO is a law that was written to help prosecutors go after major figures in organized crime. Even if guilty, the doctor and his nurses are clearly not gang kingpins, yet they potentially face life in prison if convicted. And it is likely that the full resources and power of the government will be brought to bear to make that happen. It is a grotesque abuse of power and a betrayal of patients and the spirit of law.
So who can really blame the doctors? Collectively perhaps, the profession does bear some responsibility for failing to stand up forcefully to the thugs in suits and uniforms who are ruining pain control. (Not all police or prosecutors deserve that term, to be sure -- some of them are even trying to help the situation -- but it only takes a few crazies in positions of power and the profession as a whole to allow them to operate to create a climate of fear that affects everyone.) Individually, there's little question that a doctor who does the right thing for a chronic pain patient is in fact stepping into the line of fire, at least outside of the academic setting where there's a little more protection.
Nevertheless, I don't believe Dr. Hurwitz is pulling out because of fear for himself. He's beaten the authorities before and he probably could again. But in the meantime, hundreds of pain patients would go untreated. Better for him to give them an opportunity to make alternate arrangements; the cops and the regulators won't give them any such warning. When Virginia's Board of Medicine suspended Hurwitz's prescribing rights back in 1996, at least one patient, a retired police officer, committed suicide from the resulting untreated pain; he recorded a dramatic video explaining his decision which was played on a Sixty Minutes report in the incident's wake. Dr. Hurwitz is trying to prevent the police and regulators from again provoking such a tragedy. Only time will show how his soon to be former patients will fare in the drug war.
By the way, my view on the Hurwitz case isn't based on mere news reports or secondhand accounts. I attended portions of the hearings in Richmond six years ago as an observer, when the medical board went after him the first time. His patients traveled distances and spent scarce cash on airfare and hotels in order to rally for their lives in his defense. There were people literally lying on the floor, moaning in pain. There was a man who had lost all his body below the waist -- but that hadn't stopped a drug squad from storming and ransacking his house -- their reason being that he had a pain prescription!
It's really that bad, and if it seemed like it was getting better for a few years, it's now getting worse. But it shouldn't be a surprise. Nearly 1.5 million people are arrested in the United States for nonviolent drug offenses every year, and nearly half a million are incarcerated. When there's a war, there are accidents and there are war crimes. The persecution of pain doctors, and the resulting mass torture of pain patients, is a war crime, and only one of the crimes committed by the drug warriors against patients every day. It's time to bring it to a stop.