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News of the Day ... in Perspective

DEA’s reneging on guidelines chills pain management

When the DEA abruptly withdrew “guidelines” developed in collaboration with pain-management experts, many physicians reacted with dismay, saying that millions of sufferers may be denied needed pain relief.

More than 90% of patients and physicians could be subject to investigation under the recently issued policy statement, stated Dr. Howard Heit, a pain and addiction doctor in Fairfax County, Va. “This approach is chilling to me, and I work with the DEA all the time,” he told reporter Marc Kaufman. “General practitioners will see this and say, `Why should I prescribe opioids and risk getting into trouble?’ ”

In a letter to the DEA, David E. Joranson of the University of Wisconsin, who led the negotiations with the agency, accused it of unilaterally changing important and long-standing practices. The changes are “likely to interfere in medical practice and pain management.”

The August guidelines had said it was legitimate for doctors to pre-date prescriptions to avoid forcing patients to return weekly for prescription refills when rules prevented dispensing an adequate quantity of medication. Russell Portenoy of the Beth Israel Medical Center in New York said that this frequent practice has been discussed and recommended in journal articles and physician training courses.

The DEA has declined to comment on criticisms of its new statement.

Some say the abrupt turnaround was triggered when Dr. William Hurwitz’s defense attorneys tried to introduce the August document into evidence.

See: Marc Kaufman, Washington Post 11/30/04, p A17.

Additional information:

See News of the Day Archives for Oct. 11 and Nov. 14, Nov. 21, and Nov. 28.

Withdrawn DEA collaborative document

News of the Day Archive