Experts Call For Balance In Addressing Under Treated Pain And Drug Abuse

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Experts Call For Balance In Addressing Under Treated Pain And Drug

Abuse

http://www.medicalnewstoday.com/medicalnews.php?newsid=39902

A balance must be struck between physicians' responsibility to treat

chronic pain and the Drug Enforcement Administration's (DEA) duty to

combat drug abuse, according to a series of seven commentaries by

national thoughtleaders published in the February issue of Pain

Medicine.

The commentaries explore the current state of the use of pain

medicine from a variety of perspectives, with an emphasis on the

tension between physicians treating legitimate pain and the DEA. Pain

Medicine is the journal of the American Academy of Pain Medicine

(AAPM).

According to the American Pain Foundation, chronic pain affects more

than 50 million Americans. People suffering from chronic pain may

need pain medicine to lead normal lives, such as being able to work

and to participate in family life. Many patients with chronic pain

have lost access to appropriate medical care due to tension between

regulatory/legislative bodies and the medical community.

The lead commentary describing current DEA policy on pain care with

controlled substances was written by A. Heit, MD, a pain and

addiction medicine specialist who has collaborated with the DEA. AAPM

President M. Fishman, MD, presents the collision of the war on

drugs with efforts to improve pain care. Bolen, JD, Former

Assistant US Attorney with the United States Department of Justice,

makes a compelling case that current DEA policies are founded on

erroneous and inappropriate positions. Covington, MD,

Passik, PhD, and Ben A. Rich, JD, PhD, add additional dimensions to

the current perceived state of imbalance, while Will Rowe, Executive

Director of the American Pain Foundation, a patient advocacy

organization, provides perspective on patient's rights.

Victories and Defeats in Pain Care

Dr. Heit and others worked with the DEA to develop the August 2004

Frequently Asked Questions and Answers for Health Care Professionals

and Law Enforcement Personnel, which the DEA subsequently disavowed

causing " confusion and consternation " among physicians who treat

pain.

" It is now apparent to me that the spirit of cooperation that existed

between the DEA and the pain community to achieve the goal of balance

has broken down. The DEA seems to have ignored the input and needs of

the healthcare professionals and pain patients who actually

prescribe, dispense and use controlled substances, " Dr. Heit states

in his commentary.

" It is essential that we resume dialogue between the DEA and

healthcare professions for the benefit of our patients and society, "

continues Dr. Heit. " The DEA and the healthcare professionals

treating pain both have an important job to do in ensuring those who

need [controlled substances] for pain receive them while preventing

misuse and diversion. Only through dialogue based on and mutual trust

and respect can this balance be restored. "

Other government initiatives have challenged the line between health

policy and law enforcement. This includes Congress's empowerment of

the DEA allowing the agency authority in reviewing new drugs, a role

previously held only by the Food and Drug Administration, according

to Dr. Fishman. On Nov. 4, 2005, Congress reversed itself and

rescinded the DEA's new authority.

As healthcare's regulatory authority shifts from health agencies to

law enforcement agencies, the DEA and Federal prosecutors have used

the courts to bypass state medical boards when scrutinizing physician

practices. Dr. Fishman says that the recently passed national law,

National All Schedules Prescription Electronic Reporting Act

(NASPER), which institutes a national prescription monitoring

program, may offer some steps forward, but it also carries the

potential to impede optimal prescribing and could even perpetuate

aberrant prescribing that may facilitate abuse. While this new law is

presented to the public as a clinical tool to improve patient care

and safety, " …profound inadequacies suggest that this law may be

intended less as a clinical tool than as a physician mouse trap, " Dr.

Fishman states.

" Healthcare decisions, including those involving legitimate use of

analgesics, must remain in the hands of healthcare professionals, "

comments Dr. Fishman. " The DEA should be required to work with health

agencies and healthcare professionals in finding common ground and

reaching the rational position of balance that is in the public's

best interest…Healthcare oversight must remain within agencies

whose primary responsibility is to improve public health. Contrary to

recent events in Washington, we must continue to insist that drug

abuse can be curbed without undermining patients in pain and striving

for such policies is in the best interest of society. The least we

can do is to make sure that the casualties of the war on drugs are

not suffering patients who legitimately deserve relief. "

Freedom to Care for Pain Patients Critical

Reluctance to prescribe powerful pain medicine among the medical

community for fear of retribution has led to the needless suffering

of countless people in pain.

The Department of Justice must " stop the abuse and diversion of

prescription medicines without harming access to these medicines for

people affected by pain, " states Will Rowe, Executive Director,

American Pain Foundation, in his commentary. The commentary points to

a failure on the part of the DEA in not abiding by its commitment to

the pain community to pursue a balance between the war on drugs and

the rights of pain patients, and also cites " the failure of those in

authority over the DEA to assert the more comprehensive command. "