One of the saddest and least noticed consequences of the war on drugs is the under-treatment and non-treatment of chronic pain. Literally hundreds of thousands of patients endure needless agony -- in some cases turning to suicide as the only available form of relief -- because they could not find a doctor willing to prescribe adequate doses of narcotics for them.
The problem is two-fold: widespread ignorance on the part of physicians on chronic pain treatment; and a threatening law enforcement bureaucracy that can ruin or even incarcerate doctors whom they see as being too liberal with their prescriptions. These two factors play into each other to perpetuate a situation in which denial of pain relief is standard practice.
On September 17, 1991, agents from the Drug Enforcement Administration and a local narcotics officer visited Dr. William Hurwitz in his Washington, DC office, stripping him of his licenses to prescribe narcotics and practice medicine. Hurwitz got his medical license back six days later, but it took nine months and $55,000 in legal fees before he could once again prescribe narcotics. The DEA moved against Hurwitz because he prescribed up to 500 milligrams a day of oxycodone, a strong opioid painkiller, to treat the severe, chronic pain of a patient suffering from bone deterioration in his hips. The standard dose of oxycodone advised at that time was only 20 milligrams, but when patients suffer from long-term, intolerable levels of pain, tolerance to the drug builds up quickly and very high doses are not only necessary for pain relief, but are also safe: addiction is extremely rare among pain patients, and after a short time period, the drugs no longer get the patients "high," but rather allow them to function normally.
The drug police are again trying to take down Dr. Hurwitz. This time it's the Virginia Medical Board, which has suspended his license in that state and is holding hearings in late June, based on the claim that Dr. Hurwitz's continued practice of medicine "constitutes a substantial danger to the public health and safety." (The DEA is almost certainly involved behind the scenes.) Hurwitz can still practice in Washington, DC, for now, but the Virginia pharmacies that had served his patients nationwide cannot fill his prescriptions. These patients are frightened that they will be unable to get pain medication; even worse, the action, if it stands, will bring the progress of chronic pain treatment to a virtual halt. As one of Hurwitz's patients, a prominent attorney, wrote: "The chilling effect this type of action has on the willingness of *any* physician to provide legitimate treatment for persons with chronic pain cannot be overstated. We will essentially be orphan patients given the right to unobstructed assisted suicide by the federal courts, but no right to a decent quality of life by any as-yet recognized body of law. These stark choices are familiar to many of us, and we must take action -- now -- before the Board itself visits upon us a `substantial danger' to *our* health and safety."
The consequences for physicians can go far beyond loss of career. In 1990, a Dr. William Polan was sent to prison after an old friend of his, George Wehner, had recruited 14 people to fake illnesses to Dr. Polan so that George could sell the drug he prescribed them, oxcydone, on the street. George testified against Dr. Polan, in order to plea bargain his sentence down to six months, while Dr. Polan, who had no one to testify against, received a mandatory minimum sentence of 12 years in prison without the possibility of parole. The sentence was determined based not only on the weight of the oxcydone, but also on the weight of the carrier mixture, aspirin or Tylenol, which was several times greater.
Requiring doctors to act as police over their patients dramatically compromises the quality of treatment of chronic pain. The Virginia Medical Board and the DEA are interfering with proper medical care and are ruining lives. You can help in any of the following ways:
1) Write the Board to protest their reckless actions. You don't have to live in Virginia to write them. Address your correspondence to:
Warren W. Koontz, M.D.
Executive Director, Board of Medicine
6606 West Broad St., 4th Floor
Richmond, VA 23230-1717
(804) 662-9943 (fax)
2) Attend Dr. Hurwitz's hearing. It is scheduled to take place on Thursday and Friday, June 20 & 21, 1996, beginning at 9:30 AM each day. The hearing could be postponed or canceled, so you should call the Board at (804) 662-9908 for verification.
3) A fund has been established for Dr. Hurwitz's defense. It will cost him $35,000 just to begin, and the total cost could run as high as $250,000. If you wish to contribute, make checks payable to his attorneys, Tate & Bywater, 2740 Chain Bridge Rd., Vienna, VA 22181, and make sure to indicate on the check that it is for the Dr. William E. Hurwitz Legal Defense Fund.
4) Distribute this bulletin to people you know, especially doctors and patients.
Dr. Hurwitz has been interviewed for the CBS Evening News. We don't yet know what day he will be featured, but it could be as soon as Thursday, May 6. DRCNet Director David Borden appeared on local television with Dr. Hurwitz and three patients/activists in Williamsburg, VA last Memorial Day weekend. The tape will be made available in the near future, and is the right length to be distributable by other local access cable stations, most of which are eager for new material. You can help get the word out by getting the video to your local access cable station, and by letting people you know about the CBS feature.
More information on the pain issue is available from the National Chronic Pain Outreach Association (NCPOA), 7979 Old Georgetown Rd., Suite 100, Bethesda, MD 20814, (301) 652- 4948, (301) 907-0745 (fax), [email protected]. You can get involved with the pain issue online by subscribing to the mailing list of the American Society for Action on Pain (ASAP); send e-mail to [email protected] with the line "subscribe ASAP your name" in the message.
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