The Under-treatment of Pain
It's no secret that pain is under treated in America. We have 65 million Americans suffering chronic pain, and only 6 thousand pain specialists. Family practitioners should be the ones who treat pain, but because of fear of regulatory agencies and the DEA, most simply refuse to treat their patients who are in pain.
The problem is the few doctors who are willing to treat pain end up with hundreds of pain patients. If a pain patient is caught selling prescription drugs, many times this starts an investigation into the doctor. I don't understand this, because the doctor has no control over what a patient does once they leave the doctor's office. Many times a doctor who is accused of over-prescribing or other violations is later cleared of some or all of the charges.
This is what happened to my first pain doctor, Dr William Hurwitz. Any doctor considering the treatment of pain should read this, www.druglibrary.org/Schaffer/asap/policestate.htm. Dr Hurwitz practiced medicine in good faith, a doctor is not a mind reader and is not responsible for the actions of their patients. Yet the federal prosecutor called him a drug kingpin.
Trapped in Arizona
Mohave County has high rate of drug use, we all know that. Being a former drug cop I understand why pain specialists require patients to sign pain contracts. Pain contracts are designed to protect the doctor by setting rules the patient must abide by or be dropped as a patient. The standard pain contract says the patient will only get pain medication from one doctor, only use one pharmacy, take random drug tests, can have their pills counted at any time to make sure they are taking the prescribed medication and not selling it on the street.
Today, pain contracts are necessary to protect the doctor, or in this case the physicians assistant from DEA and other regulatory agencies. The problem with pain contracts is that they protect the doctor but apparently not the patient.
I've had a year-long relationship with my pain doctor, have always done the required tests and kept my appointments. So when told the physicians assistant I was going to was visiting grandkids in Oregon and Montana this summer, I needed him to write 90 days of pain medication rather than the normal 30 days.
The physicians assistant went into the office to talk to someone, then returned and told me that I was free to try to find other doctors as I traveled, and that I wouldn't be dropped as a patient for violation of the pain contract I signed.
I was baffled that they were unwilling to follow the 2007 DEA rule change allowing physicians to write three separate prescriptions with staggered fill dates to give patients the equivalent of a 90-day prescription for schedule II controlled substances.
This policy reversal by the DEA eliminated the burden previously imposed on patients with cancer or chronic pain who were forced to visit their physician every month for new pain medicine prescriptions when there was no medical necessity to do so.Prior to this rule change pain patients were literally trapped by only 30 days of medication.
All legitimate patients with pain should continue to work for a pain patients bill of rights, and debate our states policies on the crises of prescription drug abuse and undertreated pain. Our state medical board should be committed to safe and effective treatment of pain, the rights of pain patients, and an effective policy on prescription drug abuse.