Pitching Relief

The strongest and most effective pain relievers are opioids, derived from the opium poppy or synthetic versions of its active compounds. In the popular imagination, and traditionally in law enforcement, opioids have been associated with addiction, moral weakness and crime. That the same compounds are a godsend to millions of suffering but otherwise unexceptional and law-abiding people is far less widely understood.

The nation's qualms about narcotic pain relief seemed to lessen in the 1990s, when many researchers concluded that the drugs were less likely to cause addiction in pain sufferers than earlier believed. While many patients will become physically dependent on opioids -- just as other patients become dependent on insulin, calcium channel blockers or anti-depression medicine -- the overwhelming majority can and will be weaned off if their pain subsides. The advent of OxyContin, a time-released, partly synthetic opioid that provides unique pain relief, added to the sense that a new day had arrived in the nation's thinking about opium-based pain relief.

But that was before OxyContin abuse and overdoses became a widespread problem in places like Appalachia and rural New England, and before local leaders and politicians began calling for stronger action to keep these prescription products from turning into a street drug of choice. It has proved very difficult to stop the criminal diversion of prescription narcotics from the nation's drug supply chain, but relatively easy to identify doctors who write large numbers of Percocet or Vicodin or OxyContin prescriptions that -- through carelessness, bad luck or, as prosecutors charge, criminal intent -- sometimes fall into the wrong hands.

Using sometimes novel legal theories, prosecutors have charged many pain doctors with prescribing opioids "outside the normal practice of medicine," and dozens are now in, or facing, jail. One of the most prominent is William Hurwitz, a nationally known pain doctor also based in Fairfax. After a trial last year, Hurwitz was convicted of 50 counts of drug trafficking, and was found responsible for the overdose death of a patient and serious injuries of two other patients. He was sentenced to 25 years in federal prison.

At the time of his sentencing, DEA Administrator Karen Tandy held up a plastic bag with 1,600 pills and said they were prescribed by Hurwitz to one patient on one day. "Dr. Hurwitz was no different from a cocaine or heroin dealer peddling poison on the street corner," she said. "Indeed he was worse, because unlike the street dealer, he had and abused the trust and authority to treat people in pain. He hid behind his white lab coat and Stanford medical degree to try to conceal the fact that he had become a common drug trafficker."

(Regarding the prescription for 1,600 pills, Hurwitz said it was a clerical error that was corrected by a pharmacist before it was filled.)

That case is now on appeal and has become -- along with several other prosecutions -- a cause celebre for advocates including those in the Pain Relief Network, who are helping Hurwitz and a number of other arrested and convicted doctors to fight the charges against them. While acknowledging that Hurwitz could have been more careful in some of his prescribing, his supporters cast him as a dedicated and courageous professional who has been railroaded by the government.

The new era in pain relief anticipated and promoted by pain doctors and drug manufacturers seems increasingly far off.

Lives Transformed

Wendy Shugol is a nationally recognized special-education teacher at Falls Church High School, a French horn player in the Fairfax City Band, a horseback rider and avid woodcarver. She also has cerebral palsy and a host of other serious conditions, and doubts she could even get out of bed were it not for the massive doses of opioids she takes daily. She says her referral to Howard Heit in 1998 marked a fundamental transformation in her life. "I'm a different person now," she says. "My life was miserable, and I was basically miserable to be around."

Shugol, 54, wheeled herself into Heit's Arlington Boulevard office two weeks ago for a monthly appointment, smiling broadly and filled with an energy seldom seen in people who don't carry her many physical burdens. The first order of business was, as always, to hand Heit her vials of drugs, so he could see exactly how many pills she had used since the last visit. Heit took out a pill counter and went to work, first on the OxyContin, and then the Dilaudid. He was puzzled to find more than 100 extra pills.

"Have you been taking everything you need?" he asked.

"Yep, but I think you made a mistake last time," she replied. Rather than writing a prescription for 230 pills, Heit had written one for 330 pills, and that's what the pharmacist filled.