FEDERAL WAR ON DRUGS THREATENS THE EFFECTIVE TREATMENT OF CHRONIC PAIN; Congressional Record Vol. 150, No. 18
(Extensions of Remarks - February 12, 2004)

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[Extensions of Remarks]
[Page E177]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


 FEDERAL WAR ON DRUGS THREATENS THE EFFECTIVE TREATMENT OF CHRONIC PAIN

                                 ______
                                 

                             HON. RON PAUL

                                of texas

                    in the house of representatives

                      Wednesday, February 11, 2004

  Mr. PAUL. Mr. Speaker, the publicity surrounding popular radio talk 
show host Rush Limbaugh's legal troubles relating to his use of the 
pain killer OxyContin will hopefully focus public attention on how the 
federal War on Drugs threatens the effective treatment of chronic pain. 
Prosecutors have seized Mr. Limbaugh's medical records in connection 
with an investigation into charges that Mr. Limbaugh violated federal 
drug laws. The fact that Mr. Limbaugh is a high profile, and often 
controversial, conservative media personality has given rise to 
speculation that the prosecution is politically motivated. Adding to 
this suspicion is the fact that individual pain patients are rarely 
prosecuted in this type of case.
  In cases where patients are not high profile celebrities like Mr. 
Limbaugh, it is a pain management physician who bears the brunt of 
overzealous prosecutors. Faced with the failure of the War on Drugs to 
eliminate drug cartels and kingpins, prosecutors and police have turned 
their attention to pain management doctors, using federal statutes 
designed for the prosecution of drug kingpins to prosecute physicians 
for prescribing pain medicine.
  Many of the cases brought against physicians are rooted in the 
federal Drug Enforcement Administration (DEA)'s failure to consider 
current medical standards regarding the use of opioids, including 
OxyContin, in formulating policy. Opioids are the pharmaceuticals 
considered most effective in relieving chronic pain. Federal law 
classifies most opioids as Schedule II drugs, the same classification 
given to cocaine and heroin, despite a growing body of opinion among 
the medical community that opioids should not be classified with these 
substances.
  Furthering the problem is that patients often must consume very large 
amounts of opioids to obtain long-term relief. Some prescriptions may 
be for hundreds of pills and last only a month. A prescription this 
large may appear suspicious. But, according to many pain management 
specialists, it is medically necessary, in many cases, to prescribe 
such a large number of pills to effectively treat chronic pain. 
However, zealous prosecutors show no interest in learning the basic 
facts of pain management.
  This harassment by law enforcement has forced some doctors to close 
their practices, while others have stopped prescribing opioids--even 
though opioids are the only way some of their patients can obtain pain 
relief. The current attitude toward pain physicians is exemplified by 
Assistant U.S. Attorney Gene Rossi's statement that ``our office will 
try our best to root out [certain doctors] like the Taliban.''
  Prosecutors show no concern for how their actions will affect 
patients who need large amounts of opioids to control their chronic 
pain. For example, the prosecutor in the case of Dr. Cecil Knox of 
Roanoke, Virginia told all of Dr. Knox's patients to seek help in 
federal clinics even though none of the federal clinics would prescribe 
effective pain medicine.
  Doctors are even being punished for the misdeeds of their patients. 
For example, Dr. James Graves was sentenced to more than 60 years for 
manslaughter because several of his patients overdosed on various 
combinations of pain medications and other drugs, including illegal 
street drugs. As a physician with over thirty years experience in 
private practice, I find it outrageous that a physician would be held 
criminally liable for a patient's misuse of medicine.
  The American Association of Physicians and Surgeons (AAPS), one of 
the nation's leading defenders of private medical practice and medical 
liberty, has recently advised doctors to avoid prescribing opioids 
because, according to AAPS, ``drug agents set medical standards.'' I 
would hope that my colleagues would agree that doctors, not federal 
agents, should determine medical standards.
  By waging this war on pain physicians, the government is condemning 
patients to either live with excruciating chronic pain or seek opioids 
from other, less reliable, sources--such as street drug dealers. Of 
course, opioids bought on the street will likely pose a greater risk of 
damaging a patient's health than will opioids obtained from a 
physician.
  Finally, as the Limbaugh case reveals, the prosecution of pain 
management physicians destroys the medical privacy of all chronic pain 
patients. Under the guise of prosecuting the drug war, law enforcement 
officials can rummage through patients' personal medical records and, 
as may be the case with Mr. Limbaugh, use information uncovered to 
settle personal or political scores. I am pleased that AAPS, along with 
the American Civil Liberties Union (ACLU), has joined the effort to 
protect Mr. Limbaugh's medical records.
  Mr. Speaker, Congress should take action to rein in overzealous 
prosecutors and law enforcement officials and stop the harassment of 
legitimate pain management physicians, who are acting in good faith in 
prescribing opioids for relief from chronic pain. Doctors should not be 
prosecuted for doing what, in their best medical judgment, is in their 
patients' best interest. Doctors should also not be prosecuted for the 
misdeeds of their patients.
  Finally, I wish to express my hope that Mr. Limbaugh's case will 
encourage his many fans and supporters to consider how their support 
for the federal War on Drugs is inconsistent with their support of 
individual liberty and Constitutional government.

                          ____________________