Keeping Americans in pain

Posted by Marc Hodak on April 5, 2007 under Unintended consequences | Be the First to Comment

The “war on drugs” is a fount of unintended consequences, on steroids. One example of the pain this war is causing us all is the literal pain it is causing millions of Americans who are having trouble getting proper treatment. Drug laws penalize doctors for prescribing high doses of medication to certain patients. The theory is that some patients are really addicts (making it illegal to treat addicts who happen to be in pain) or dealers who are just taking advantage of the medical system to make a buck. The problem is, doctors have a notoriously difficult time telling real patients from fake ones. That wasn’t a big section on the board exam. Listening to patients and caring for them was. Do such laws really chill the treatment of pain? Ask Dr. Hurwitz. As reported in the New York Times:

Dr. Hurwitz, depending on which side you listen to, is either the most infamous doctor-turned-drug-trafficker in America or a compassionate physician being persecuted because a few patients duped him.

When Dr. Hurwitz, who is now 62, was sent to prison in 2004 for 25 years on drug trafficking and other charges, the United States attorney for Eastern Virginia, Paul J. McNulty, called the conviction ���a major achievement in the government���s efforts to rid the pain management community of the tiny percentage of doctors who fail to follow the law and prescribe to known drug dealers and abusers.���

Yes, that was 25 years. For a doctor who didn’t directly profit from the sale of the drugs.

Dr. James N. Campbell, a Johns Hopkins University neurosurgeon specializing in pain, has this to say about this prosecution:

���Opioids were a revolution in pain treatment during the 1990s, but doctors are now more reluctant to use them,��� Dr. Campbell says. ���If a doctor perceives there���s a 1 in 5,000 chance that a prescription will lead to a D.E.A. inquiry ��� just an inquiry, not even an arrest ��� he���s not going to take the chance. So the victims are the patients.���

OK, let’s say that the actual deterrence threshold was a one-in-50 chance; this is still far from theoretical problem…

Here was a comment to NYT’s John Tierney’s first blog post of the retrial describing an encounter with a well-recommended orthopedist:

Almost as soon as he walked in the examining room, he began to state strongly and repeatedly that he would not give me a prescription for painkillers. I had not mentioned anything about medicine, indeed I had plenty of painkillers and unfilled prescriptions for such already�Ķand was still in incredible and unrelenting pain (pain, by the way, being a condition I am more than familiar with, having suffered from psoriatic arthritis since 1983). I have no history of substance abuse, indeed don���t even drink as a matter of preference-yet the visit devolved into a quagmire of confrontation with the doctor reiterating his refusal and me practically begging him to look at my cat-scans, mri���s etc and just try to figure out what the hell was going on with my shoulder. As it turned out, about a month and 1/2 later during a surgery to debride the collarbone, it was discovered, amongst other detritus, that a bone spur had dislodged during my injury and was apparently lodged between my rotator cuff and acromia from what I understand�Ķso yeah, I had been in pain.

Even if the drug laws were the least bit effective in their nominal intent, I’ll leave it the reader to decide what the equation should look like: (a) number of incidents of suffering of like this lady’s, versus (b) the number of “hits” an addict may get from a duped doctor.