Crackdown on Drugs Hits Chronic-Pain Patients

Amid Tighter Regulation Of Painkillers, Physicians Pull Back on Prescriptions

By JANE SPENCER
Staff Reporter of THE WALL STREET JOURNAL

The government's widening crackdown on prescription-drug abuse is having an unintended consequence: It's making it tougher for people with
chronic pain to get treatment. In recent weeks, federal regulators have sharply dialed up their effort to combat the black market in pain killers. The White House Office of National Drug Control Policy this month announced a $148 million plan
targeting illegal use of prescription tranquilizers, sedatives and other drugs, with a goal of curbing the flow of drugs such as OxyContin to abusers.

Separately, the Drug Enforcement Administration is reviewing a proposal to reclassify hydrocodone, the most commonly prescribed pain drug in the U.S., in a more tightly regulated class of drugs. If the switch occurs, patients would be unable to get refills without obtaining a new prescription from a doctor.  

State regulators are stepping up their own efforts as well. Some 20 states already have implemented some form of prescription-monitoring plan to help track doctors who prescribe narcotics, the DEA says. Lawmakers in at least six more states are considering similar plans.  

The problem is that many of the opium-derived prescription drugs that can successfully treat severe chronic pain -- such as oxycodone and
hydrocodone -- also command high premiums on the street market. Rising abuse rates, and the media frenzy generated by celebrity addiction cases
like Rush Limbaugh, have increased pressure on regulators.

Patients with chronic pain say the government initiatives are making it harder for them to get the painkillers they need to battle conditions
such as arthritis and cancer. The crackdown is making doctors more reluctant to prescribe some drugs out of fear they will attract attention from regulators. Doctors are also getting more vigilant. One Tennessee doctor turned in a patient he believed wasn't actually taking a prescription painkiller. The arrest took place in the doctor's office. The DEA has been aggressively prosecuting doctors who prescribe large amounts of painkillers that wind up on illegal markets. The agency is
trying to reduce the number of so-called pill mills -- unscrupulous doctors who write prescriptions for narcotics to anyone who asks. The DEA has arrested 50 doctors in the year that ended last September, for issues related to improper prescribing, including five cases where doctors allegedly were trading prescriptions for sexual favors,
according to the DEA. "Doctors can't be pill pushers," says Bob Williamson, deputy chief in the office of diversion control at the DEA. "Legally, they are treated like drug dealers."

Doctors say the prosecutions are ensnaring legitimate physicians. Advances in the way doctors treat chronic pain during the past decade
have led to more use of opioids, in higher doses, as part of an aggressive approach in difficult pain cases.

The trouble began when OxyContin hit the market in 1996. Most traditional pills have just a few hours' worth of opioids, but it used a time-release formula that jammed 12 hours' worth into one pill. That meant patients could get consistent relief for long stretches of time -- without the roller coaster pain-relief cycle that can be caused by drugs that wear off more quickly.

But abusers quickly realized they could grind up the pills -- defeating the time-release formula -- and inject or snort the powder to get a massive hit of the drug  all once. By the late '90s, OxyContin was a favorite on the street market.

The practice of prescribing drugs such as these carries increasing legal risks for doctors. If a patient turns around and sells the drugs, the
doctor can be held legally responsible, according to the DEA. Doctors also can be charged if a patient abuses a drug. In 2002, a Florida
do