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Specialists Decry DEA Reversal on Pain Drugs

New Rules Called A 'Step Backward'

By Marc Kaufman
Washington Post Staff Writer
Tuesday, December 21, 2004; Page A08

Three medical associations representing pain specialists have sent the Drug Enforcement Administration an unusual joint letter sharply critical of its recently revised guidelines on prescribing pain medicines.

The letter, signed by the presidents of all three groups, called a DEA policy statement published in November in the Federal Register "an unfortunate step backward" that encourages a return to "an adversarial relationship between [doctors] and the DEA."

Already concerned about what they saw as sometimes over-aggressive prosecutions of doctors, pharmacists and other health professionals who prescribe narcotic painkillers such as OxyContin, the specialists said the new DEA position threatens their ability to provide care to millions of patients.

The presidents wrote that despite the DEA's assurances that it does not want to discourage doctors from providing proper narcotic medication to people in pain, the new guidelines "will undoubtedly have the exact opposite effect on any practitioner reading them."

DEA spokesman Bill Grant said in response that the agency "wishes to reassure the public that the withdrawal of the August [statement] does not represent any change in DEA's investigative emphasis or approach. Physicians acting in good faith and in accordance with established medical norms should remain confident that they may continue to dispense appropriate pain medications."

He said the DEA is working on a process to gather the views of the medical community as it refines its policy.

The letter from the heads of the American Pain Society (APS), the American Academy of Pain Medicine (AAPM) and the American Society of Addiction Medicine (ASAM) is a response to a Nov. 16 DEA statement that repudiated some parts of a jointly negotiated set of guidelines that had been introduced with fanfare in August.

The August guidelines -- in the form of answers to 29 frequently asked questions -- were the result of two years of discussion and negotiation between pain specialists and the DEA. They were embraced by many doctors as a breakthrough in resolving a deepening conflict between law enforcement and pain management practitioners.

The August guidelines were posted on the DEA Web site and given an enthusiastic review in the Journal of the American Medical Association. But less than two months later, the agency took the document down and replaced it with a notice saying some of the earlier statement was inaccurate and did not represent a DEA policy statement.

The pain specialists' letter took particular aim at the agency's new description of prescribing practices that can lead to a DEA investigation. The DEA said doctors who prescribe high dosages of opioid painkillers to patients for long periods of time are subject to investigation. It also said the government can open investigations on the suspicion that a doctor is diverting controlled drugs or to make sure there is no improper activity.

In reply, the three pain groups wrote: "Reading that the government can investigate merely on suspicion that the law is being violated will send chills down the spine of practitioners who are treating patients with [narcotic painkillers] and will certainly contribute to the undertreatment or non-treatment of moderate to severe chronic pain." The letter was signed by APS President Dennis C. Turk, AAPM President Samuel J. Hassenbusch and ASAM President Lawrence Brown.

Separately, five past presidents of the American Pain Society wrote a joint letter criticizing the courtroom testimony of Michael Ashburn, who was the government's expert witness in the recent high-profile trial of William E. Hurwitz, a prominent McLean pain doctor. The letter, sent to Hurwitz's attorney, accused Ashburn, who is also a past president of the group, of making factual errors in describing appropriate prescribing.

"We are stunned by his testimony," the letter said. "As leaders in this field, we feel compelled to correct the errors in his testimony, lest it be used in the future in a manner that worsens the national tragedy of untreated pain."

Hurwitz was convicted in U.S. District Court in Alexandria last week of 50 counts of drug trafficking for his prescribing of opioids to patients.


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