The Association of American Physicians and Surgeons, in a letter to the judge in the Hurwitz case, charged he was convicted on the basis of “false expert testimony”, which it described as “egregious.”
Their letter said, “That a tiny percentage of his patients then broke the law with their prescriptions does not justify imprisoning Dr. Hurwitz for the rest of his life. A conviction based on this false medical testimony should not stand….”
The Hurwitz situation is not isolated. Throughout the U.S., physicians have been prosecuted, jailed, or have lost their licenses to practice medicine. In addition to Hurwitz, Dr. Ronald McIver is serving 30 years, Dr. Freddie Williams is serving life, and Dr. James Graves received a 62-plus-year sentence for diversion in 2002.
According to Prof. Libby, who has become an authority on the subject, “Many doctors have been convicted and almost no one has been acquitted.” He told us, “Most attorneys tell their clients to cop a plea and not fight it in court.”
Richard Paey was convicted of fraudulently submitting multiple copies of opioid prescriptions to treat chronic pain. He was in New Jersey where his doctor treated him, but then moved to Florida where he was unable to find a physician to write prescriptions to treat his pain.
Frightened by what they term a “brutal display of executive power”, most doctors, including those in the field of pain management, have simply abandoned this sickest and most vulnerable segment of our population. Patients suffering from mild to moderate pain, and requiring low dosages of opioids may still find care, but those patients with high dosage requirements are increasingly shut out of care altogether.
In 2004 it was estimated that many of the 5,000 pain specialists in the United States, would not prescribe opioids. Those few medical practices that do treat chronic pain with opioids impose severe restrictions on patients’ freedoms. Prof. Libby told us that many doctors are now prescribing over-the-counter medications such as aspirin and Tylenol, “which are far more dangerous than opioids if taken in large quantities.”
The DEA claims it investigates less than one per cent of physicians who prescribe OxyContin or other drugs covered by the Controlled Substances Act. The agency reported arresting 34 doctors out of 963,385 registered doctors in 2003, for selling opioids to addicts or drug dealers for money, sex, or favors. That is less than 0.001% of the total number of licensed doctors, the DEA said.
But critics dispute that figure. Prof. Libby told us, “In 2001, the DEA carried 861 investigations of doctors. If we use this figure instead of 34 arrests it means that more than 17 percent of the roughly 5,000 doctors who treat pain patients were investigated. That means that than one out of every six doctors who treat chronic pain patients were under criminal investigation.”
A not-for-profit advocacy group, the Pain Relief Network, is suing to have the Controlled Substances Act declared unconstitutional, and is seeking to enjoin the DEA from enforcing the law against physicians.
To calm its critics, the DEA commissioned several pain specialists to work with Federal officials to create guidelines for physicians who treat pain with opioids. These guidelines were posted on the agency's website, and most doctors were led to believe that following the recommendations would keep them safe from prosecution.
But that understanding didn't last long. Late last year the guidelines were taken off the DEA's website. The agency claimed it wasn't bound by any standards or practices when it came to determining what physicians it would investigate.
Removal of the guidelines coincided with Dr. Hurwitz’s trial. The doctor’s attorneys attempted to have the guidelines admitted as evidence on the belief that Hurwitz's practice conformed to their parameters. They failed. A few weeks after Hurwitz's judge refused to admit the guidelines as evidence, the DEA renounced them, and essentially declared it had carte blanche to launch an inquiry.
David Jorenson, the academic pain specialist who headed the committee that authored the original guidelines, sent the agency a sharply-worded rebuke. Three other professional associations representing pain specialists followed with a second letter. And the National Association of state Attorneys General wrote to the DEA, expressing concern that the agency was overstepping its bounds and interfering with the legitimate treatment of pain. The letter was signed by 30 AGs from both parties.
However, the DEA remains unmoved, insisting its revocation of the guidelines did not represent a shift in policy and that its pursuit of doctors should have no effect on legitimate pain treatment.
Dr. Alexander DeLuca, MPH, a member of the American Academy of Preventive Health and a Policy Analyst and Board Member of the Pain Relief Network, told us, ”Relations between physicians and the DEA have probably never been worse in modern times.”
William Fisher has managed economic development programs in the Middle East and elsewhere for the US State Department and the US Agency for International Development. He served in the international affairs area in the Kennedy Administration and now writes on subjects ranging from human rights to foreign affairs for a number of newspapers ond online journals.
