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Common Sense for Drug Policy unveiled a new Public Service Ad on the pain management issue in early January 2005. The ad focuses on the DEA's rejection of guidelines for pain management prescribing. The ad cites a Washington Post article on the subject in which "Dr. David Joranson, head of the University of Wisconsin Group, says the 'DEA's abrupt withdrawal of support for the [Guidelines] without consulting with coauthors about their concerns, raises questions about what advisory role, if any, the pain management community can expect to have with DEA.' The agency's changes, he says, 'are likely to interfere in medical practice and pain management.'" This ad, scheduled to run in winter 2005, is also available as a camera-ready PDF. The DEA announced in early October that its recently issued document, "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel" (see DEA Issues New Guidelines For Pain Prescriptions below), has been pulled from circulation. According to the DEA's notice, "The document contained misstatements and has therefore been removed from the DEA Web site. DEA wishes to emphasize that the document was not approved as an official statement of the agency and did not and does not have the force and effect of law. DEA recognizes that the proper use of controlled substances in the treatment of pain remains an extremely important issue. Accordingly, DEA intends to address this matter in the future." In August 2004, the Drug Enforcement Administration issued guidelines for physicians regarding prescription of pain medication. According to an Associated Press report carried by the Wisconsin State Journal on Aug. 12, 2004 ( "Doctors Get Guidance On Painkillers"), "Many doctors hesitate to prescribe narcotics, which are heavily regulated because they can be abused by addicts. The guidelines issued Wednesday, written by leading pain specialists together with the DEA, stress that the drugs are safe for the proper patient - -- and pledge that doctors won't be arrested for providing legitimate therapy." AP reported that "They come at a crucial time, said co-author David Joranson, pain policy director at the UW Medical School. Fewer doctors are willing to prescribe narcotic painkillers, known as opioids, partly because of the government's high-profile crackdown on prescription-drug abuse. Some pharmacies won't stock them for fear of burglaries. 'In some ways, pain management and the use of pain medications has become a crime story when it really should be a health-care story,' Joranson said. The key message from the guidelines: 'These are legitimate treatments. They're essential for good medical care,' said Dr. Russell Portenoy, pain chief at New York's Beth Israel Medical Center and a well-known pain specialist. June Dahl, a UW-Madison professor of pharmacology, called the guidelines 'a great step toward reducing the barriers' to the treatment of severe pain. She added that doctors have been reluctant to give adequate doses because of 'excessive fear' they might be investigated. 'It's amazing how much confusion there still is. There is a reluctance to give adequate doses. It kind of seems unbelievable that there is a reluctance to treat people who are dying, especially since there's no evidence that you can get addicted.' The story notes that "The DEA is distributing the guidelines to agents and prosecutors to help them distinguish aggressive pain management from drug diversion. A lot of opioid-taking patients in a practice shouldn't by itself signal suspicion, the guidelines advise, while long-distance prescribing and lots of premature refills might. Fear of the DEA isn't the only obstacle. Many nonspecialists simply don't know much about opioids. Consider Cynthia C. Hildt, 65, a retired New York teacher who hunted relief for disabling back pain for 20 years before Portenoy prescribed morphine. Recently another doctor asked if she wasn't afraid of addiction. 'I said, I seem to have the choice of living with this unconscionable pain or taking a pill that will help, and I don't believe that addiction is a worry under those circumstances,' Hildt said. Indeed, the new guidelines stress that when prescribed properly for serious pain, opioids hardly ever lead to addiction. 'Clearly, the risk is small unless someone has a history of substance abuse,' Dahl said. About 30 percent of Americans suffer chronic pain; for as many as a third, it can be disabling, Portenoy said. How many need opioids but are undertreated? About 40 percent of cancer and AIDS patients and the terminally ill, populations where opioids are considered optimal care, he said." The DEA's publication, "Prescription Pain Medication: Frequently Asked Questions and Answers For Health Care Professionals, and Law Enforcement Personnel," is available as a PDF.
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