Treating Doctors as Drug Dealers: The Drug Enforcement Administration's War on Prescription Painkillers

By Libby, Ronald T. | Independent Review, Spring 2006 | Go to article overview

Treating Doctors as Drug Dealers: The Drug Enforcement Administration's War on Prescription Painkillers


Libby, Ronald T., Independent Review


Untreated pain is a serious problem in the United States. Given the difficulties in measuring a condition that is untreated, estimates of the number of people affected vary, but most experts agree that tens of millions of Americans suffer from undertreated or untreated pain. The Society for Neuroscience, the largest organization of brain researchers, estimates that 100 million Americans suffer from chronic pain (Hall 1999). The American Pain Foundation, a professional organizations of pain specialists, puts the number at 75 million-50 million from serious chronic pain (pain lasting six months or more) and an additional 25 million from acute pain caused by accidents, surgeries, and injuries. The societal costs associated with untreated and undertreated pain are substantial. In addition to the obvious cost of needless suffering, damages include broken marriages, alcoholism, family violence, absenteeism and job loss, depression, and suicide (American Pain Foundation n.d.). The American Pain Society, another professional group, estimates that in 1995, untreated pain cost American business more than $100 billion in medical expenses, lost wages, and other costs, including 50 million workdays (American Pain Foundation 2002, 1) A 2003 article in the Journal of the American Medical Association puts the economic impact of common ailments such as arthritis, back pain, and headache alone at $61.2 billion per year (Stewart et al. 2003).

Chronic pain can be brought on by a wide range of illnesses, including cancer, lower back disorders, rheumatoid arthritis, shingles, postsurgical pain, fibromyalgia, sickle cell anemia, diabetes, HIV/AIDS, migraine and cluster headaches, broken bones, sports injuries, and other trauma.

According to one 1999 survey, just one in four pain patients received treatment adequate to alleviate suffering (American Pain Foundation 2004; see also Wisconsin Medical Society 2004, 16). Another study of children who died from cancer at two Boston hospitals between 1990 and 1997 found that almost 90 percent of them had "substantial suffering in the last month and attempts to control their symptoms were often unsuccessful" (Wolfe et al. 2000, 326). In a formal policy statement issued in 1999, the California Medical Board found "systematic undertreatment of chronic pain," which it attributed to "low priority of pain management in our health care system, incomplete integration of current knowledge into medical education and clinical practice, lack of knowledge among consumers about pain management, exaggerated fears of opioid side effects and addiction, and fear of legal consequences when controlled substances are used" (Hall 1999). The American Medical Association (AMA) stated in a 1997 news release that 40 million Americans suffer from serious headache pain each year, 36 million from backaches, 24 million from muscle pains, and 20 million from neck pain. An additional 13 million suffer from intense, intractable, unrelenting pain not related to cancer. Most of those patients, the AMA warned, receive inadequate care because of barriers to pain treatment. A 2004 survey of the medical literature published in the Annals of Health Law found documented widespread undertreatment of pain among the terminally ill, cancer patients, nursinghome residents, the elderly, and chronic-pain patients, as well as in emergency rooms, postoperative units, and intensive-care units (Dilcher 2004).

One reason chronic pain remains undertreated is that few doctors specialize in the field. Dr. J. David Haddox, the vice president of health affairs at Purdue Pharma L.D., the manufacturer of the long-acting opioid medications OxyContin and MSContin, estimates that only 4,000 to 5,000 doctors who specialize in pain management treat the 30 million chronic pain patients who seek treatment in the United States (personal communication, November 11, 2004)-about one doctor for every 6,000 patients.1 In Florida, just one percent, or 574, of the state's 56,926 doctors prescribed the vast majority of narcotic drugs paid for by Medicaid in 2003 (Schulte 2003, 1). …

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Treating Doctors as Drug Dealers: The Drug Enforcement Administration's War on Prescription Painkillers
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