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August 19, 2005 - Orange County Register (CA)

OpEd: Inflicting Pain

The Misguided War On Drugs Keeps Patients From Needed Medication

By Michael Arnold Glueck, M.D. and Robert J. Cihak, M.D.

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Millions of Americans are living in chronic pain. But a federal offensive against pain management is driving some doctors out of practice, keeping others from treating patients, and forcing many to undertreat patients.

In 1914, five years before America embarked on that greatest of all failed prohibitions, Prohibition, Congress passed the Harrison Act.

This law, one of the final products of the Progressive regulatory binge, outlawed the non-medical use of opium, morphine and cocaine.

As with Prohibition, the Harrison Act created a new criminal class, this time about 250,000 patients and their doctors.

The struggle against addiction has evolved into a war against effective treatment of chronic pain.

In 1970, the Harrison Narcotics Act was replaced by the Drug Abuse Prevention and Control Act, which initiated the War on Drugs.

In 1975, the Supreme Court ruled that Drug Enforcement Administration licensed doctors "can be prosecuted when their activities fall outside the usual course of professional practice" as if every patient and medical situation could be pigeonholed as "usual" and no different from any others.

Until the 1990s, the DEA mostly focused on illegal black market drugs, such as cocaine, crack and marijuana.

But in 2001, fomented by erroneous media and legislative scares, the DEA created a new mission for itself, combating the illegal diversion of a legal prescription drug, OxyContin.

Ironically, these scares were shouted from the housetops during the same time that the medical profession learned that properly managed opiate pain-control drugs could be used safely and effectively to break the pain cycle caused by failure of the body's internal pain- control systems when overloaded with chronic pain.

We also learned that, properly managed, almost every patient taking these medicines for chronic pain relief easily stops taking these drugs when the pain-causing condition is resolved.

These patients become "physically dependent" on the drugs for pain relief but do not suffer addiction, that is, do not suffer cravings for the substance and compulsively use the substance and continue to use it in spite of harm it might be causing them.

It's even a bit much for other prosecutors. Thirty state attorneys general expressed concern about the DEA's quicksand-solid position this January.

They signed a letter to the DEA complaining, saying that "we have learned that adequate pain management is often difficult to obtain because many physicians fear investigations and enforcement actions if they prescribe adequate levels of opioids or have many patients with prescriptions for pain medications."

People suffering chronic pain are suffering because DEA agents are telling doctors how to do their jobs. The war on drugs is causing suffering or taking the lives of too many innocent patients and the livelihoods of innocent doctors.

It's time to prohibit this prohibition against treating pain. The real problem is dealing with those who believe that regulation and prosecution can solve all our problems.

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