The growing controversy over the clash between the imperatives of medicine and those of the drug war when it comes to the use of opioids for pain treatment was the topic of ABC News' Nightline program Wednesday night. With guests including Dr. Russell Portenoy of New York's Beth Israel Hospital and Siobhan Reynolds of the Pain Relief Network, advocates for an enlightened approach to effective pain treatment through opioids were well-represented.
Viewers also heard from two men supporters consider martyrs of the pain relief movement, wheelchair-bound Richard Paey, and imprisoned Northern Virginia pain specialist Dr. William Hurwitz, who was convicted on drug-dealing conspiracy charges over his prescribing practices in November and was sentenced to 25 years in prison last month.
The late-night news program also featured DEA administrator Karen Tandy, who seemed somewhat on the defensive as she described concerns that doctors were being persecuted for compassionate prescribing as "a misperception." The DEA is just doing its job, she said. "DEA does not dictate the legitimate practice of medicine. We deal in enforcing the laws against criminal conduct. And these examples of cases where doctors are prosecuted, that small number of doctors, there are very extreme facts in those cases. And so I think that there is a misperception here."
But with the bulk of the program focusing of people like Paey and Hurwitz, Tandy's point was open to challenge. The program featured sympathetic reportage as well as talk, with extensive coverage of Paey's case. Florida prosecutors admitted they had no evidence Paey had ever sold his pills to others, and Paey denied it. "I think a true pain patient would never sell their medication," he said. "It's too hard to get." His case is a classic example of law enforcement interfering in medicine and treating pain patients as addicts and criminals, he said. "It's a culture that's creating fear among the patients and the doctors," he said. "It's turning patients against doctors and the doctors against the patients." Only now, in prison, ironically, is Paey receiving adequate pain treatment.
There was also reportage on Dr. Hurwitz, a nationally-known leader in cutting edge pain management. While Hurwitz and his supporters argued that he was a scapegoat in a larger federal crackdown on pain doctors, the DEA's Tandy downplayed the problem. "The number of doctors that have been arrested by DEA or the number of cases that DEA's participated in is less than one-hundredth of one percent of all the registered doctors," Tandy said. "It was 42 this year. It was 50, a little over 50, last year. So it's a very small number of doctors."
That didn't reassure Portenoy, who told ABC he and his colleagues are increasingly worried about the arrest and prosecution of doctors prescribing opioid pain medicines. "Physicians, in the last, year have begun to view the DEA as an adversary or have begun to feel increasingly suspicious that the DEA is so focused on prescription drug abuse that they're willing to sacrifice appropriate medical care, at least in certain circumstances, in order to reduce prescription drug abuse," Portenoy said. And the program ended with the host commenting that even valid pain prosecutions may scare doctors and cause patients to go untreated for chronic pain.
The issue of the contradiction between the needs of pain patients and the fears of drug law enforcers is now making its way out of the hospitals and courthouses of America and into the media spotlight. It's about time.