"Something is terribly wrong with the way some criminal justice authorities have begun to enforce the law against physicians and pharmacists who prescribe and dispense high dose opioids to treat chronic pain. The necessary balance in pain policy... has tipped drastically in the direction of ruthless drug control and away from compassionate collaboration. This is a recent development. The past five years has generated an unprecedented list of health care providers charged with murder for allegedly providing inappropriately large quantities of opioids to pain patients."
-- Dr. David Brushwood, Mayday Scholar with the American Society of Law, Medicine and Ethics, September 4, 2003
Dr. Deborah Bordeaux used to be a pain management specialist. Now she's a convicted felon facing a 100-year prison sentence as a drug dealer. Bordeaux was arrested when the Drug Enforcement Administration (DEA) and South Carolina law enforcement raided the Myrtle Beach clinic where she once prescribed opioids to severely ill patients. Siobhan Reynolds is a New York City-based film documentarian with a chronically ill life partner. When Reynolds attended Bordeaux's trial earlier this year, the South Carolina doctor's ordeal and the apparent miscarriage of justice prompted Reynolds to found a new group to advocate for pain patients and the health care workers who treat them, the Pain Relief Network (http://www.PainReliefNetwork.org).
Now Reynolds has enabled Bordeaux to find expert legal talent for her appeal, and the Pain Relief Network has called for the Food and Drug Administration (FDA) to quit cooperating with the Justice Department in classifying drugs under the Controlled Substances Act. The appeal is now more timely than ever, as the number of physicians charged by overzealous state or federal prosecutors grows ever larger. In Myrtle Beach, three of Bordeaux's coworkers have pled guilty in the face of potentially horrendous sentences (like Bordeaux's) if they don't. In Roanoke, Virginia, Dr. Cecil Knox is on trial on similar charges -- what prosecutors call operating a "pill mill" -- but what the cutting edge of pain management considers well within the bounds of contemporary medical practice. (In an indication of what may really be going on, one of the state's witnesses against was unable to recognize him in the courtroom last week.) And Thursday, Dr. William Hurwitz, a nationally known pain specialist from northern Virginia was arrested on drug trafficking charges related to his prescription practices. (See the newsbrief on Hurwitz's arrest this issue --http://stopthedrugwar.org/chronicle/304/hurwitz.shtml -- and look for extensive coverage of this late-breaking story and the coordinated attack on pain doctors next week.)
And there are more, a growing number of physicians indicted and sometimes convicted of being drug traffickers but who say they were only doing what was best for patients. Dr. Robert Weitzel from Utah, Dr. Stan Naramore from Kansas, Dr. Frank Miller from California -- all were charged with murder or manslaughter, but saw either the charges dropped in the face of medical evidence or the verdicts overturned in appeals based on the medical evidence. Others were not so lucky. Florida Dr. James Graves sits in prison pending appeal after being convicted of manslaughter, while three other physicians face murder charges related to their prescribing opioids. The Association of American Physicians and Surgeons (http://www.aapsonline.org) maintains a list of more than 30 doctors it contends have been unfairly prosecuted over pain management issues.
On September 9, the Pain Relief Network addressed the FDA in response to the rising tide of physician prosecutions and urged it to halt cooperation with the Justice Department until Justice recognizes the current medical understanding of what constitutes acceptable pain care practices. Under the Controlled Substances Act, the FDA must holding hearings on drugs and "advise" the Attorney General as to their proper classification. PRN's Reynolds told the FDA committee the process was fraught with mischief since the Justice Department, through its prosecutions of physicians, had proven it was not interested in the scientific or medical evidence.
Explaining that because her ex-husband had suffered severe pain and problems getting it treated, she eventually formed a listserv for patients and physicians interested in the issue, Reynolds then told the committee what came next. "One by one, I watched as several of our most prominent members were arrested and charged with murder, or subjected to accusations of violating the Controlled Substances Act. I knew, as I watched, that something was going terribly wrong," she said. Reynolds described watching the trial of Dr. Bordeaux. "I sat alongside her and two other doctors tried on similar charges. I was shocked and dismayed to learn that the Justice Department was bringing out of date, antiscientific, prejudicial testimony into a US courtroom in the hopes of convincing the jury that by prescribing medication in conformity with the actual, up to date standard of care, the standard I was familiar with, that these doctors had done something shameful, something unspeakably wrong."
Hundreds of physicians have now been charged with CSA violations because of Justice's stubborn adherence to outdated science, she told the committee. "I'm here to tell you that a terrible misunderstanding has occurred here and that the public health has been inestimably damaged. All over America doctors have simply put down their pens, patients in pain have returned to their beds or committed suicide. The suffering and destruction of innocent life is unimaginable," Reynolds said. "PRN is therefore calling on you to suspend your cooperation with the DOJ and to stand solely for your primary commitment to safeguard the public health."
"What we need is a congressional investigation," Reynolds told DRCNet, "and now at least maybe this FDA panel has some idea. They were shocked. I had said the unsayable. The acting head of the committee thanked me for my testimony and suggested I serve on the panel as a patient advocate," she related. "He said I ought to apply for a seat, but oddly enough, I haven't been able to get a call back from them."
Reynolds and the PRN have taken a first step toward bringing the looming crisis in pain management care into the bowels of the federal bureaucracies. But with federal prosecutors cutting down pain doctors like weeds and congratulating themselves for jailing the "drug dealers," this is a battle that is far from over.
Note: DRCNet is currently seeking major funding to help the pain movement and rein in the out-of-control prosecutions of doctors. Please contact David Borden at (202) 362-0030 or [email protected] for further information.