In an editorial in the April 12 edition of American Medical News, the house organ of the American Medical Association (AMA), the nation's largest physicians' organization again expressed concern that the federal government's ongoing campaign against prescription drug abuse is leading to people in pain going untreated (http://www.ama-assn.org/amednews/2004/04/12/edsa0412.htm).
While the AMA called the federal government's effort to crack down on the illicit use of prescription drugs "an essential goal," it noted that the government figure of 6.2 million Americans abusing prescription drugs is far exceeded by the tens of millions of Americans who suffer chronic pain without being able to get adequate treatment. The government effort to crack down on prescription drug abuse "must not discourage patients and physicians from appropriately treating chronic pain," said the editorial. "Some of the methods used to control drug abuse make physicians fearful of prescribing opioid painkillers for patients who truly need these medications."
That was a rather oblique reference to the ever growing list of pain management physicians who have been indicted by the Justice Department as pill-shilling Dr. Feelgoods and threatened with decades in federal prison. While those indictments often end in acquittals or convictions only on peripheral charges, the impact of those prosecutions has been chilling on physicians.
While the AMA has not been as quick as some other professional organizations and patient advocacy groups to denounce federal abuses of pain patients and the doctors who seek to treat them, it has worked for the last several years to educate law enforcement about current best practices in pain treatment. Three years ago, the AMA joined other health organizations in signing an agreement with the Drug Enforcement Administration in which the agency promised to try to balance the conflicting goals of ensuring that pain is adequately treated and simultaneously cracking down on the abuse of prescription pain suppressants.
Given what has occurred since then, and particularly since the announcement of the new federal offensive against prescription drug abuse a few weeks ago, the AMA is understandably concerned that the balanced approach it sought has been thrown off-kilter. While the editorial said the AMA supported the call for cracking down on illicit internet pharmacies and the push to implement prescription monitoring programs in the states, it warned that such programs "must maintain physician-patient confidentiality, lest patients shy away from seeking treatment for prescription drug abuse," while they must not "increase physicians' liability by holding doctors at fault for not requesting patients' prescribing histories." Doctors might choose to do so, the AMA noted, but the patient-doctor relationship is built on trust, which could be damaged by laws that require doctors to "check up" on their patients.
The AMA even has concerns about the continuing medical education training program it has made available for physicians. While nearly 100,000 doctors have reviewed the pain management program, its effectiveness "could be compromised significantly if the program were viewed by physicians as an enforcement tool instead of an educational tool," the AMA wrote in a letter last month to Drug Enforcement Administration Administrator Karen Tandy.
For the AMA the bottom line is "the prevention and treatment of pain disorders through aggressive and appropriate means, including in many cases opioid pain relievers." Doctors who appropriately prescribe such drugs to relieve pain "should not be subject to the burdens of excessive regulatory scrutiny, inappropriate disciplinary action, or criminal prosecution."
Read the AMA editorial online
Read the AMA position statement
on pain management using opioid analgesics online at:
Read the Bush administration's
position on prescription drug abuse online at: