The group is asking the DEA not to impede "the legitimate practice
of medicine," but the agency says it is not a barrier to care.
Robeznieks, AMNews staff. Feb. 21, 2005.
A new voice has joined the chorus claiming that recent actions by the U.S.
Drug Enforcement Administration appear to impede the prescribing of controlled
substances to treat pain.
The National Assn. of Attorneys General, in a Jan. 19 letter, called on DEA
Administrator Karen P. Tandy to meet with representatives of the organization
to "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."
The letter was signed by the attorneys general from 29 states and the District
of Columbia. The effort was led by Oklahoma Attorney General and NAAG Past
President W.A. Drew Edmondson, who said he was approaching the issue from a
"If our consumers are not receiving what they need and want as health
care consumers, then that's a problem for the attorney general,"
Edmondson said. "The new position of the DEA has at least the potential
-- if not the actual effect -- of being a barrier to doctors prescribing the
proper drugs for treating pain. I fully support efforts to combat diversion,
but we have to find ways to combat diversion that does not impact on good
Edmondson said it appears that investigating physicians might be the new focus
of DEA anti-diversion efforts, and he disagrees with that approach. "We
should concentrate on drugs that are illegally on the streets and work
backward from that to find out how they got illegally on the streets," he
said. "It should not be the other way around looking at doctors."
In August 2004, after working for more than two years with experts in the
field of pain medicine, the DEA released a frequently-asked-questions document
on prescribing controlled substances for pain treatment that sought to balance
physician concerns about effective treatment and law enforcement issues
regarding diversion of prescription drugs. The DEA removed the document from
its Web site in October 2004, and posted a notice in the Nov. 16 Federal
Register stating that the document contained incorrect information. Some
physicians said the new policy statement appeared to criminalize more
Most Americans say they would prefer to die at home, free of pain and without
unwanted medical intervention.
On Jan. 18, another notice was posted notifying the public that the agency was
in the process of preparing another document and was seeking comments from
physicians and other interested parties about what they wanted the document to
The NAAG letter expressed surprise that the DEA "apparently shifted its
policy" from balancing medical and law enforcement concerns.
"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," the letter stated.
DEA spokesman Rusty Payne denied there had been a shift in policy.
"DEA has not changed any policy related to this issue," Payne said
in an e-mail. "The reason for taking down the FAQs was simply because
there was some information that was incorrect. ... DEA has not changed its
enforcement emphasis with respect to investigating physicians involved in the
illegal prescribing of pharmaceutical narcotics."
He added that no meeting had been scheduled with the NAAG.
Most Americans die in a hospital or nursing home.
Attorney and pain medicine advocate Mary Baluss, the director of the Pain Law
Initiative in Washington, D.C., said she cheered when she first saw the NAAG
letter, but then her enthusiasm was dampened somewhat when she saw that
attorneys general for 21 states had not signed the letter.
Edmondson, however, was satisfied with the signatures the letter received.
"Getting all 50 to sign is pretty near impossible -- getting three
attorneys in a room to agree on something is problematic," he said.
Edmondson's interest in pain treatment stems from his work promoting better
He said that interest was sparked when he attended a bioethics program where
he learned that most Americans would prefer to die at home with friends and
family, free of pain and without unwanted medical intervention. Instead, he
said, most Americans die in pain at a hospital or nursing home.
"I was thinking, 'What's wrong with this picture and what can I do about
it?' " Edmonson said.
He formed an end-of-life care task force in Oklahoma and, while serving as the
2002-03 NAAG president, selected end-of-life care as the subject of his
"There has been an increased focus, I believe, by medical licensing
boards on the undertreatment of pain and, with the shift by the DEA, doctors
are in a tough, tough position," Edmondson said. "Anything we can do
to lessen that squeeze, I believe, is helpful, and that's the purpose of the
letter to the DEA."
American Medical Association policy states that "physicians who
appropriately prescribe and/or administer controlled substances to relieve
intractable pain should not be subject to the burdens of excessive regulatory
scrutiny, inappropriate disciplinary action or criminal prosecution."
Robeznieks, AMNews staff. Feb. 7, 2005.
The U.S. Drug Enforcement Administration is preparing a document that will
address its role as defined by the Controlled Substances Act. The DEA has
invited physicians and others to submit comments on what they would like the
document to address.
According to the announcement, published in the Jan. 18 Federal Register,
those interested have until March 21 to submit comments.
The announcement was the latest in a series of notices about a
frequently-asked-questions document on prescribing controlled substances for
pain treatment that was posted on the DEA Web site in August 2004 and then
withdrawn in October.
The document took more than two years to finish and was co-authored by the DEA,
the University of Wisconsin Pain & Policy Studies Group and the Last Acts
Partnership, with Russell K. Portenoy, MD, serving as the panel's lead expert
on pain treatment.
Dr. Portenoy, chair of the Dept. of Pain Medicine and Palliative Care at New
York's Beth Israel Medical Center and faculty member for the AMA online series
on pain treatment, said he had little enthusiasm for going through the process
But PPSG Director David Joranson said it appeared that there were new people
at the DEA working on prescription drug diversion, and they need to be
educated on the issues. "I think everyone in the pain field --
clinicians, administrators and patients -- should take the DEA request very
seriously," he said.
Joranson said the FAQ document was valuable in that it educated clinicians on
law enforcement's drug diversion concerns, and it informed law enforcement
about medical issues.
The president-elect of the American Academy of Pain Medicine, Scott Fishman,
MD, said he would mention this in a letter to the DEA. "It will reiterate
the position of balance, assert that aggressive pain medicine is possible
without perpetuating addiction, and caution regulators about policies that try
to solve the problem of drug diversion by restricting access to pain medicine
of those who legitimately need them," he said.
The DEA said it had no comment.
Since Feb. 27, 2005 Your are visitor
to this page