An article in the current New England Journal of Medicine examines how the DEA‘s influence on medical practices for pain control ultimately harm patients. Although the article focuses on end-of-life pain control, the issues affect people with chronic pain as well. The authors assert,
“Uncontrolled pain and other distressing symptoms are the primary concerns and greatest fears of patients facing serious illness. More than 90 percent of the pain associated with severe illness can be relieved if physicians adhere to well-established guidelines and seek help, when necessary, from experts in pain management…. Despite the efficacy of opioids and a commitment by the medical profession to treat pain, abundant evidence suggests that patients’ fears of undertreatment of distressing symptoms are justified. Although a lack of proper training and overblown fears of addiction contribute to such undertreatment, physicians’ fears of regulatory oversight and disciplinary action remain a central stumbling block.”
Again, this is in the context of palliative care, so the practices are a different; the implications are much the same.
Using the NEJM article as a springboard, today’s New York Times addresses the core problem: Currently policy places fear of prescription drug addiction above the lives of people with pain. There’s little regard for those who wonder if a life with excruciating pain is better than no life at all.
The author describes how doctors’ hands are tied to some extent, and that how they work within these restrictions to treat patients or simply turn away from the dilemma all together.
“…[T]he D.E.A. has recently increased raids on doctors’ offices, confiscating files and arresting doctors on charges of overprescribing narcotics to patients who are addicts or drug dealers.
“Most of these physicians are compassionate people trying to help suffering patients but are sometimes fooled by clever addicts, drug dealers or undercover agents who fake their pain.
“Yes, there are bad apples among members of the medical profession. There are some doctors who charge for medical exams that they never do and provide phony patients with prescriptions for narcotics to feed their habits or sell on the street.
“But should all physicians be subject to intense scrutiny by the D.E.A. and risk arrest and prosecution, leaving legitimate patients to suffer intensely or scramble to find other doctors willing to risk taking them on?
“The growing number of arrests of pain management specialists is exacting high costs for patients, physicians and medical insurers. Some doctors order costly but unnecessary diagnostic tests so they can show the D.E.A. a reason for prescribing strong pain medication.
“Many doctors are simply unwilling to prescribe narcotics, no matter how much a patient suffers. Ignorance, as well as a fear of the D.E.A., plays a role.”
Want to help get this mess sorted? Visit the American Pain Foundation‘s advocacy page for ways you can help. One quick way to contribute is to send a pre-written e-mail to your congressional representatives.
I can’t create a blog-safe link for the Times article. You’ll have to register with the newspaper to read it; even then, the link will expire in about a week.