Ron Paul Classic: War on Opioids and Doctors or War on Patients?

Shortly after the U.S. Senate passed legislation authorizing the creation of "best-practices" for pain management, the Center for Disease Control unveiled new "guidelines" for the use of pain medicines.

While the guidelines are non-binding, the fact they come from a federal agency means they will influence the way regulators, insurance companies, and even malpractice lawyers, judge, and juries adopt issues related to pain management. Thus, every American who suffers from, or could suffer from, or has a loved one who suffers from, extreme pain -- meaning every American -- should be concerned about these "guidelines."

Jacob Sullivan writing at Reason magazine provides more details:

But doctors who internalize the CDC's overwrought concerns about addiction and overdose (more on those in a minute) will be inclined to avoid opioids even when the alternatives are only half as effective, leaving patients to suffer unnecessary pain. The CDC wants doctors who are already inclined to treat patients complaining of pain with suspicion to be even more leery. It recommends interrogation and urine testing aimed at discovering illicit drug use, ostensibly to inform clinical decisions. It does not explicitly say that someone who, say, admits consuming cannabis or tests positive for it should be denied the drugs he needs to control his pain, but you can be sure that will be the result in some cases.

Read the whole piece here.

Kentucky Senator Rand Paul has proposed making it easier for physicians to treat heroin addiction by repealing federal regulations that make it more difficult to treat addicts:

U.S. Senator Rand Paul of Kentucky says Congress is close to approving a bill that will help combat heroin addiction in his home state. Speaking at a medical town hall in Bowling Green today, the Republican lawmaker said federal restrictions have too often stood in the way of giving heroin users effective treatment for their addictions.

Under current law, doctors can prescribe suboxone to 30 patients at a time in the first year, and 100 the following year. Suboxone can help lessen dependence on the drug. Paul is co-sponsoring a bill to increase the cap to 500 patients. "There is said to be a million patients who need to be treated but don't have a doctor to go to because of this federal law limiting access," Paul says. Paul said those limits have maxed out doctors.

"They didn't want people to prescribe too many of the drug replacements, like the pill-mill, so they limit the number of patients. But as a consequence, they made the number small enough. And there aren't many doctors treating heroin addicts that now there's more heroin addicts than doctors that they can see," he says.

In 2004, following radio talk show host Rush Limbaugh's legal troubles for his use of painkillers, Campaign for Liberty Chairman Ron Paul addressed how federal drug laws interfered with effective pain treatment:

Mr. Speaker, the publicity surrounding popular radio talk show host Rush Limbaugh's legal troubles relating to his use of the pain killer OxyContin will hopefully focus public attention on how the federal War on Drugs threatens the effective treatment of chronic pain. Prosecutors have seized Mr. Limbaugh's medical records in connection with an investigation into charges that Mr. Limbaugh violated federal drug laws. The fact that Mr. Limbaugh is a high profile, and often controversial, conservative media personality has given rise to speculation that the prosecution is politically motivated. Adding to this suspicion is the fact that individual pain patients are rarely prosecuted in this type of case. In cases where patients are not high profile celebrities like Mr. Limbaugh, it is a pain management physician who bears the brunt of overzealous prosecutors.

Faced with the failure of the War on Drugs to eliminate drug cartels and kingpins, prosecutors and police have turned their attention to pain management doctors, using federal statutes designed for the prosecution of drug kingpins to prosecute physicians for prescribing pain medicine. Many of the cases brought against physicians are rooted in the federal Drug Enforcement Administration (DEA)'s failure to consider current medical standards regarding the use of opioids, including OxyContin, in formulating policy. Opioids are the pharmaceuticals considered most effective in relieving chronic pain. Federal law classifies most opioids as Schedule II drugs, the same classification given to cocaine and heroin, despite a growing body of opinion among the medical community that opioids should not be classified with these substances.

Furthering the problem is that patients often must consume very large amounts of opioids to obtain long-term relief. Some prescriptions may be for hundreds of pills and last only a month. A prescription this large may appear suspicious. But, according to many pain management specialists, it is medically necessary, in many cases, to prescribe such a large number of pills to effectively treat chronic pain. However, zealous prosecutors show no interest in learning the basic facts of pain management. This harassment by law enforcement has forced some doctors to close their practices, while others have stopped prescribing opioids--even though opioids are the only way some of their patients can obtain pain relief.

The current attitude toward pain physicians is exemplified by Assistant U.S. Attorney Gene Rossi's statement that ``our office will try our best to root out like the Taliban.'' Prosecutors show no concern for how their actions will affect patients who need large amounts of opioids to control their chronic pain. For example, the prosecutor in the case of Dr. Cecil Knox of Roanoke, Virginia told all of Dr. Knox's patients to seek help in federal clinics even though none of the federal clinics would prescribe effective pain medicine. Doctors are even being punished for the misdeeds of their patients. For example, Dr. James Graves was sentenced to more than 60 years for manslaughter because several of his patients overdosed on various combinations of pain medications and other drugs, including illegal street drugs.

As a physician with over thirty years experience in private practice, I find it outrageous that a physician would be held criminally liable for a patient's misuse of medicine. The American Association of Physicians and Surgeons (AAPS), one of the nation's leading defenders of private medical practice and medical liberty, has recently advised doctors to avoid prescribing opioids because, according to AAPS, ``drug agents set medical standards.'' I would hope that my colleagues would agree that doctors, not federal agents, should determine medical standards. By waging this war on pain physicians, the government is condemning patients to either live with excruciating chronic pain or seek opioids from other, less reliable, sources--such as street drug dealers. Of course, opioids bought on the street will likely pose a greater risk of damaging a patient's health than will opioids obtained from a physician. 

Finally, as the Limbaugh case reveals, the prosecution of pain management physicians destroys the medical privacy of all chronic pain patients. Under the guise of prosecuting the drug war, law enforcement officials can rummage through patients' personal medical records and, as may be the case with Mr. Limbaugh, use information uncovered to settle personal or political scores. I am pleased that AAPS, along with the American Civil Liberties Union (ACLU), has joined the effort to protect Mr. Limbaugh's medical records.

Mr. Speaker, Congress should take action to rein in overzealous prosecutors and law enforcement officials and stop the harassment of legitimate pain management physicians, who are acting in good faith in prescribing opioids for relief from chronic pain. Doctors should not be prosecuted for doing what, in their best medical judgment, is in their patients' best interest. Doctors should also not be prosecuted for the misdeeds of their patients. Finally, I wish to express my hope that Mr. Limbaugh's case will encourage his many fans and supporters to consider how their support for the federal War on Drugs is inconsistent with their support of individual liberty and Constitutional government.

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