Drug Enforcement Administration Issues Statement To Clarify Guidelines on Pain Treatment
A new statement to clarify guidelines for the prescription of pain medication published by the Drug Enforcement Administration on Nov. 16 has left "many pain doctors and patients more fearful than before that they could be arrested for practicing what they consider good medicine," the Washington Post reports. DEA published the statement after agency officials in October said that the guidelines contained misstatements.
According to the Post, the statement "toughened the agency's position on some of the most sensitive issues." For example, according to the statement, "it is a long-standing legal principle that the Government 'can investigate merely on suspicion that the law is being violated, or even just because it wants assurances that it is not.'"
In addition, according to the statement, the number of patients who receive prescription narcotics, the number of tablets they receive and the length of treatment "may indeed be indicative of diversion," although the earlier guidelines said that they "do not, by themselves, indicate a problem."
According to the statement, "The document will be aimed at providing guidance and reassurance to physicians who engage in legitimate pain treatment while deterring the unlawful conduct of a small number of physicians and other DEA registrants who exploit the term 'pain treatment' as a pretext to engage in prescription drug trafficking."
Some pain management experts have raised concerns that the new statement could prompt physicians to deny proper medications to patients. Howard Heit, a pain and addiction specialist, said that "over 90%" of patients and doctors could be subject to investigation under the revised guidelines. He added, "This approach is chilling to me, and I work with the DEA all the time. General practitioners will see this and say, 'Why should I prescribe opioids and risk getting into trouble?'"
Russell Portenoy, a pain specialist at Beth Israel Medical Center who was involved in negotiations with DEA, said, "We're seeing more of an emphasis on law enforcement and less on the legitimate use of prescription narcotics," adding that DEA changed the "tone of the dialogue in a way that is very worrisome" (Kaufman, Washington Post, 11/30).