The Politics of Pain

DRCNet. Posted October 4, 2004.

The fledgling effort to get Congress to do something about the creeping crisis in pain management in the United States took another small step forward Sept. 17, when the Association of American Physicians and Surgeons and more than 60 endorsing groups brought a briefing on pain issues to Capitol Hill. While according to the National Institutes of Health, more than 48 million Americans suffer from chronic pain, the actions of the Drug Enforcement Administration (DEA) are only exacerbating the problem, a panel of experts and activists told a crowd of staffers, lobbyists, doctors and patients.

Although there has been a rising public clamor over DEA overzealousness in pursuing its goal of preventing "drug diversion," most particularly around the prosecution of physicians engaged in opioid pain treatment therapies, Congress has yet to take much interest. In July, Rep. Ron Paul (R-TX) and Rep. John Conyers (D-MI) made the first attempt in Congress to deal with the issue by seeking to amend the Justice Department appropriations bill to bar the DEA from prosecuting doctors for prescribing legal drugs, but that amendment was ruled out of order the same day.

The same two representatives hosted the briefing, "The Politics of Pain and Painkillers: Drug Policy and Patient Access to Effective Pain Treatments," featuring presentations by doctors, pain treatment advocates and media critics. California physician Dr. Frank Fisher told a rapt audience his story of persecution at the hands of state authorities.

The head of a pain clinic, Fisher was arrested and charged with murder in the deaths of three people. After years of prosecution, all the charges melted away, but despite Fisher's eventual exoneration, the damage has been severe. Fisher remains unable to practice medicine as he fights a final battle with the state medical board, and his patients have been scattered to the wind in an all-too-often fruitless search for adequate pain treatment.

"Frank Fisher's presentation was very powerful," said the Rev. Ronald Myers, an Arkansas-based physician and founder of the American Pain Institute, who also addressed the briefing. "He has lost so much – his practice, his livelihood – because of an overzealous prosecution. It is really immoral that law enforcement went after that man," Myers said.

"But Frank Fisher was blessed because he had good legal representation. We've got other doctors who haven't fared so well. Down in Florida, Dr. Freddy Williams in serving a life sentence now. Hear what I said: Jailed for life! We've got a real struggle ahead," he said.

A key element of that struggle is getting Congress to pay attention to the problem, said Siobhan Reynolds, founder and president of the Pain Relief Network, an advocacy group for pain patients. "We want House and Senate judiciary committee and health committee hearings," she said. "We cannot begin to address this problem until we understand the scope of and the enormity of the impact on the sickest people in our society," she said. "We will not make progress until Congress really begins to grapple with this."

Part of that process is grappling with misconceptions and media distortions, as panelists Ronald Libby and Maia Szalavitz did on the Hill that afternoon. Libby, a political scientist from the University of North Florida, explained to the attentive audience how a poorly and sensationally reported series of articles about in the Orlando Sentinel painting Oxycontin abuse as a serious public health menace helped pave the way for February congressional hearings on "the national epidemic of Oxycontin addiction." The series seriously overstated the number of Oxycontin-related overdose deaths, Libby said, a charge which the newspaper has accepted, publishing a retraction of its reporting and firing the reporter this year.

Libby also drew an analogy to the 1914 Harrison Narcotics Act, which early 20th century law enforcement used to arrest and prosecute thousands of doctors for the then-common practice of prescribing opiates for maintenance purposes to addicts. The law did not explicitly ban maintenance prescribing, but enforcement agencies claimed that such prescriptions went outside the realm of accepted medical practice and therefore violated the Act. Today's prosecutors are out of control in a similar fashion, reshaping the practice of medicine according to an agenda not determined by doctors or informed by medical realities, through prosecutions of physicians accompanied by draconian prison terms or the threat thereof.