From the New York Times by Tina Rosenberg published March 26,2005:

"Federal prosecutors in Virginia want Dr. William Hurwitz, recently convicted on 50 counts of distributing narcotics, to go to prison for life without parole when he is sentenced in mid-April.

For the 50 million or so Americans who suffer from chronic pain, the fate of Dr. Hurwitz should be of some interest. He is a prominent doctor committed to aggressive treatment of pain. His behavior in some cases was inexcusable. Patients for whom he freely provided large prescriptions should, at the very minimum, have been given more close supervision. But malpractice should be cause for loss of license.

Instead, Dr. Hurwitz has been prosecuted as a drug kingpin because some patients sold their pills, although prosecutors never claimed he made a penny from it. That sends a chilling message to doctors who treat people with extreme pain.

Dr. Hurwitz's case involved prescriptions for opioids like OxyContin or Vicodin. Abuse of those drugs can be a lethal problem, but the new consensus among pain doctors is that very high doses are appropriate in some chronic pain cases. The Drug Enforcement Administration apparently disagrees. The Hurwitz case shows that increasingly it is the D.E.A., not doctors, that decides what is appropriate therapy.

Last August the D.E.A. published policies to guide doctors in treating pain. The document said the amount or duration of pain medicine prescribed was a physician's decision and would not by itself spark a criminal investigation. Dr. Hurwitz's lawyers filed to introduce it as evidence. Mysteriously, it suddenly disappeared from the D.E.A. Web site. The agency then announced it contained "misstatements." In November, the agency published new guidelines that said doctors who prescribe high dosages of opioids for long stretches are subject to investigation.

Pain is already undertreated in America. Although pain experts estimate that perhaps one in 10 people who suffer from chronic pain could benefit from opioids, the vast majority will never find this out. Many doctors won't prescribe opioids, especially in high doses. Opioids are safe and nonaddictive if used correctly, but addictive and deadly if crushed and injected or snorted, which defeats their time-release mechanism.

Abuse of narcotics like OxyContin is a serious problem and has devastated many communities. But a huge amount of OxyContin on the street is stolen from pharmacies - 1.5 million tablets from 2001 to 2003, according to the D.E.A.

Diversion of prescriptions may account for only a small part of the abuse, but it has brought a sadly disproportionate response from authorities. For example, Richard Paey, who has used a wheelchair since a car accident in 1985 and also developed multiple sclerosis, is serving a 25-year prison sentence in Florida for fraudulently obtaining prescriptions for Percocet even though prosecutors acknowledged he consumed all the pills himself.

Dozens of doctors have been charged with drug trafficking because the D.E.A. felt they were prescribing too many pills. The Association of American Physicians and Surgeons warns doctors to think twice before treating pain. "Discuss the risks with your family," it says.

One California doctor who prescribed opioids, Frank Fisher, was charged with five counts of murder - including that of a patient who died as a passenger in a car accident. All charges were dropped. A doctor in Florida, James Graves, is serving 63 years for four counts of manslaughter involving overdoses by people who either abused their prescriptions or mixed their prescribed medicines with other drugs.

Dr. Hurwitz, a crusader for aggressive pain treatment, had a controversial practice. More than 90 percent of his patients were genuine, and many say he was the only doctor who quieted their chronic pain. But his willingness to treat patients other doctors shunned, including drug addicts, also attracted scammers. It is legal to prescribe to addicts who are in pain, and many respected pain doctors believe that in some cases, addiction is caused by untreated pain and ends when the pain is controlled.

Dr. Hurwitz, who was disciplined by medical boards several times, testified that he did dismiss 17 patients he concluded were abusing their prescriptions and was tapering down the dosage for others. But he also said he felt that cutting off patients was tantamount to torture, and he did not do so without strong evidence of bad behavior.

Many of Dr. Hurwitz's colleagues believe that he was far too slow to accept such evidence and that he should not have been practicing medicine. But while he was blind to his patients' deceptions, there has never been any evidence that he was part of their conspiracy. In the prosecutors' post-trial motions, they argue that the conviction should stand even if Dr. Hurwitz believed he was prescribing for a legitimate medical purpose."

His prosecution seems inexplicable except as a signal to other doctors that they can go to prison for life for being duped by their patients. That signal is being heard - the exodus from aggressive treatment of pain is increasing. This might marginally reduce the amount of opioids on the street, but in the process it will sentence hundreds of thousands of people to suffer needlessly.

what is this world coming to? people in pain are just going to suffer because of the strongarm tactics of the federal government ( just had to throw in my two cents) thank you

Great article and seems to genuinely appear unbiased - if anything it is sympathetic to CPers. I would truly like to know when becoming part of the DEA required a medical degree. That whole thing is totally mind-blowing.

Light

Sorry folks, I do not mean to offend, BUT, this is the kind of Government YOU asked for, "Look after us" "Protect us from "terrorist" even if it means giving up doctrines that gave us the right to risk, the right to the pursuit of happiness...Do you REALLY believe in the crap that is being spoon fed to you daily? "The American Dream" it's mythology.
Please don't whine about it now. If anyone actually believes The burning "Bush" gives a flying rip about middle class americans you are as fooling yourself. We are paying a high price because of we are a nation of over-fed, lethargic cows, waiting to be herded to jail for the price of pain.
Someone told me, if I hate this country why don't I move?...send me a ticket and I am gone. I don't hate America, I hate what it has become.
Bless you all.
David

David,

I want to respond to your post, but I am not sure how clearly it relates to my post on the NY Times article. However, I think your ideas are worthy of debate and discussion, so I'll give my 2c. Or my $10 (ggg).

I appreciate where you are coming from...however, this is NOT the government *I* or many asked for. First of all, there has been a lack of candidates that support the fair and balanced paincare mandate. And secondly, I never voted for any candidate that clearly rejected our cause. Just because Bush won does not mean everyone supported him. That needs to be clarified. There are many, like me, who felt alienated because we had no choice for someone "on our side". Why can't I whine about it now? I have every right to complain about the disparities and flaws within our system. There were no candidates who supported our cause on the ballot, despite a strong group of citizens supporting it, at least on the national level, so I have every right to feel disillusioned.

Plus, I have never said Bush gave a hoot about the issue, in fact I know he could care less. I guess you were responding to a different poster.

And I beg to differ that we are all a nation of over-fed, lethargic cows. I am certainly NOT lethargic (hence my opinionated posts) and definitely not over-fed. And remember, Bush won by a narrow margin, with this victory not including MANY non-voters who disagree with his platform. And why should I move just because Bush managed to win? There are plenty of people who agree with my point of view, and rightfully so. We have a right to disagree with the powers that be - why in the world does that mean we should up and move? To be sure, there are a fair amount of misinformed, uneducated sheep amongst us, but even if they won by a slight majority, that doesn't make them right, nor does it make them the true majority.

I know this is not a popular opinion, but I believe that voting should be a mandatory part of citizenship. Like Taxes. Some people may not like it, but then we would have a more accurate view of the real public opinion. And then, even those disillusioned, the disgusted, the citizens who have long given up on the system would be forced to cast their vote. Think about it - then there would be less of a question of who the people really wanted. Sure, there will still be a divided vote, but there would be no question about the TRUE majority. Even more so than taxes, I think the privileges we are afforded in this country demand some kind of input back into system, a contribution if you will. And in the end, there would be a truer picture of what the people really want. And none of that ridiculous banter about "what if" more people came out to vote. The obligation to vote would be a small price to pay for a true democracy.

As an aside - regarding the "American Dream"...I don't think it's mythology. I think it's just completely subjective. My idea of the American dream would most probably differ from other people's view. For each person, it's a personal fantasy built upon years of indoctrination and propaganda - but it all depends on what propaganda you've been subjected to. Either way, it's a highly unatainable goal. The carrot at the end of the stick to be precise.

Thanks for your input.

David,

I can give my short answer. I did everything in my power to avoid this administration.

Light

Again, I don't want to rain on anyone's parade, but it wouldn't have made a rats a*s difference who won the presidency this last time. This type of stuff has been going on for forty (40) years now. California, not noted as a Republican stronghold, has some of the most draconian drug laws and regulations when it comes to pain medications. I loved the article presented, but the direction it pointed out has been a thoroughly bi/non-partisan affair. JMHO
PB