January 19, 2005
Karen P. Tandy
Administrator
Drug Enforcement Administration
2401 Jefferson Davis Highway
Alexandria, VA 22301
Dear Ms. Tandy:
We, the undersigned Attorneys General, write to express our concern
about recent DEA actions with respect to prescription pain medication
policy and to request a joint meeting with you. Having consulted with
your Agency about our respective views, we were surprised to learn that
DEA has apparently shifted its policy regarding the balancing of
legitimate prescription of pain medication with enforcement to
prevent diversion, without consulting those of us with similar
responsibilities in the states. We are concerned that state and
federal policies are diverging with respect to the relative emphasis
on ensuring the availability of prescription pain medications to
those who need them.
Subsequent to DEA endorsement of the 2001 Joint Consensus Statement
supporting balance between the treatment of pain and enforcement against diversion and
abuse of prescription pain medications, the National Association of Attorneys General
(NAAG) in 2003 adopted a Resolution Calling for a Balanced Approach to Promoting
Pain Relief and Preventing Abuse of Pain Medications (copy attached). Both these
documents reflected a consensus among law enforcement agencies, health care
practitioners, and patient advocates that the prevention of drug abuse is an important
societal goal that can and should be pursued without hindering proper patient care.
The Frequently Asked Questions and Answers for Health Care Professionals and
Law Enforcement Personnel issued in 2004 appeared to be consistent with these
principles, so we were surprised when they were withdrawn. The Interim Policy
Statement, “Dispensing of Controlled Substances for the Treatment of Pain” which was
published in the Federal Register on November 16, 2004 emphasizes enforcement, and
seems likely to have a chilling effect on physicians engaged in the legitimate practice of
medicine. As Attorneys General have worked to remove barriers to quality care for
citizens of our states at the end of life, we have learned that adequate pain management is
often difficult to obtain because many physicians fear investigations and enforcement
actions if they prescribe adequate levels of opioids or have many patients with
prescriptions for pain medications. We are working to address these concerns while
ensuring that individuals who do divert or abuse drugs are prosecuted. There are many
nuances of the interactions of medical practice, end of life concerns, definitions of abuse
and addiction, and enforcement considerations that make balance difficult in practice.
But we believe this balance is very important to our citizens, who deserve the best pain
relief available to alleviate suffering, particularly at the end of life.
We understand that DEA issued a “Solicitation for Comments on Dispensing of
Controlled Substances for the Treatment of Pain” in the Federal Register yesterday. We
would like to discuss these issues with you to better understand DEA’s position with
respect to the practice of medicine for those who need prescription pain medication. We
hope that together we can find ways to prevent abuse and diversion without infringing on
the legitimate practice of medicine or exerting a chilling effect on the willingness of
physicians to treat patients who are in pain. And we hope that state and federal policies
will be complementary rather than divergent.
Lynne Ross, Executive Director of NAAG, will contact you soon to arrange a
meeting at a mutually agreeable time, hopefully in March when Attorneys General will
be in Washington, DC to attend the March 14-16 NAAG Spring Meeting. We hope to
meet with you soon.
Thank you.
Sincerely,
Attorney General Drew Edmondson
Attorney General of Oklahoma
Attorney General Gregg Renkes
Attorney General of Alaska
Attorney General Mike Beebe
Attorney General of Arkansas
Attorney General Richard Blumenthal
Attorney General of Connecticut
Attorney General Thurbert E. Baker
Attorney General of Georgia
Attorney General Tom Miller
Attorney General of Iowa
Attorney General Gregory D. Stumbo
Attorney General of Kentucky
Attorney General Terry Goddard
Attorney General of Arizona
Attorney General Bill Lockyer
Attorney General of California
Attorney General Robert Spagnoletti
Attorney General of District of Columbia
Attorney General Lisa Madigan
Attorney General of Illinois
Attorney General Phill Kline
Attorney General of Kansas
Attorney General Charles Foti
Attorney General of Louisiana
Attorney General Steven Rowe
Attorney General of Maine
Attorney General Michael A Cox
Attorney General of Michigan
Attorney General Jeremiah Nixon
Attorney General of Missouri
Attorney General Jon Bruning
Attorney General of Nebraska
Attorney General Wayne Stenehjem
Attorney General of North Dakota
Attorney General Roberto Sánchez Ramos
Attorney General of Puerto Rico
Attorney General Joseph Curran Jr.
Attorney General of Maryland
Attorney General Mike Hatch
Attorney General of Minnesota
Attorney General Mike McGrath
Attorney General of Montana
Attorney General Patricia Madrid
Attorney General of New Mexico
Attorney General Hardy Myers
Attorney General of Oregon
Attorney General Patrick C. Lynch
Attorney General of Rhode Island
Attorney General Henry McMaster
Attorney General of South Carolina
Attorney General Mark Shurtleff
Attorney General of Utah
Attorney General Darrel McGraw
Attorney General of West Virginia
Attorney General Paul Summers
Attorney General of Tennessee
Attorney General William Sorrell
Attorney General of Vermont
