20 July 2005

More on pain and drug law

As a followup to the last post. Here's an earlier comment from Lindsay. I mentioned this here.
NYT article
There's been a lot of talk about medical malpractice "reform" lately. Bush says that OB-GYNs are unable to practice their "love" because they're afraid of getting sued. Nobody is talking about the much worse legal injustice facing the medical profession: doctors who are going to jail for practicing good medicine.

Pain specialists who prescribe large quantities of opiates to patients with chronic pain are being harassed by law enforcement. Some are losing their licences, some are even being sent to jail. The physicians are being flagged, charged, and convicted by law enforcement who want to keep drugs off the street.

The irony is that the doctors most likely to be targeted are those who deliver the standard of care for patients with severe pain. There are a lot of sanctimonious pronouncements in medical journals and in the mainstream media about how serious pain is and how important it is to treat pain aggressively.

[...] Last August, the D.E.A. publicly acknowledged the need for a "principle of balance" to address the necessity of access to pain medications and the approaches to containing abuse, addiction and diversion. It published "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel," which thoughtfully explained the concepts, and offered clear descriptions of the circumstances under which the D.E.A. may prosecute a doctor. Mysteriously, however, in early October the agency pulled the document from the Web site, saying it had "misstatements."

The D.E.A. declined to elaborate on its reasons for pulling the document. Some people have speculated that the agency was worried that the information could be used to help clear physicians charged with trafficking.[...]

The current climate is forcing doctors to practice bad medicine:

"We are unable to refer patients to doctors who will treat pain, if only because once a name gets out there, patients understandably flock, and then the doctor is targeted," said Siobhan Reynolds of Pain Relief Network, a patient advocacy group based in New York. The Association of American Physicians and Surgeons, based in Tucson and dedicated to the concerns of private practitioners, has gone so far as to warn doctors against managing chronic pain, lest they face of years of harassment and legal fees, even prison. "If you do," the association enjoins, "first discuss the risks with your family."

Scattered evidence confirms these impressions. A 1998 survey of more than 1,300 physicians by the New York State Medical Society found that 60 percent were moderately or very concerned about the possibility of being investigated by regulatory authorities for prescribing opiates for noncancer pain.

A third said they prescribed lower quantities of pills and lower dosages "frequently" because of the possibility of eliciting an investigation. When asked how often they avoided prescribing a preferred drug for noncancer pain, because doing so required triplicate forms, half said "frequently."

Brings a whole new meaning to "evidence based medicine", doesn't it?


No comments: