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Where are the Non-Surgical Pain Physicians?

According to Internist William Hurwitz, the actions of our government, in acting inconsistently and like a "police state" have caused him and other pain treatment veterans to retire.

And as they go, so goes your hope of ever getting long-term opioids for chronic non-cancer pain in the future. Doctors are very slow to forget actions by government entities. It usually takes them 3-4 lifetimes to forget. So your choice will only be to go under the knife, take kidney and gut damaging NSAIDS, or have "interventional" spine procedures done to your spine. Thankfully, these sometimes work very well. But the choice should be yours and they are not always the best and safest solution.

"The price
of freedom is
constant vigilance."
Thomas Jefferson

William E. Hurwitz, M.D., J.D. is an internist, whose practice has been devoted for the last few years to the management of patients with intractable pain with opioid medications. He is a member of the American Pain Society and of American Academy of Pain Medicine which has a delegate with the AMA.

A brief excerpt of his article is below and should be read carefully by those who want access to future pain relief for their loved ones and themselves.

On August 31, 2002, I announced my decision to phase out my pain practice by the end of this year unless the persecution of physicians devoted to the treatment of chronic pain with opioid medications is brought under the control of competent medical authorities. I have made this decision in response to a prosecutorial approach that targets physicians based on the misbehavior of a small percentage of their patients who may be involved in illegal behavior.

When doctors are charged, their practices are closed summarily, without warning and without provision for cushioning the blow to innocent and suffering patients. The patients are subjected to the abrupt cutoff of medications and clinical support. The stigma that those people suffer, both as pain patients on opioid medications in general and as former patients of accused doctors in particular, tends to foreclose most opportunities for effective continuing care. I announced my decision four months in advance of my expected closing date to provide my patients an opportunity to make other arrangements for care and to prevent the disruptions that would follow closure of my practice without warning by the authorities.

The full text of my announcement may be read at www.drhurwitz.com.

In this article, I want to elaborate on the context of my decision and on the kinds of policies that would allow the medical profession to be more responsive to the mostly hidden epidemic of untreated and inadequately treated pain.

Over the last decade, the prevalence and severity of chronic pain in the U.S. has been increasingly appreciated. According to a recent survey, 9 percent of US adult population (25 million people) suffer from moderate to severe pain, two-thirds of whom (16 million) have had their pain for more than five years. The majority of those with the most severe pain do not have it under control and suffer substantially in their enjoyment of life, their social relations, and their economic productivity.

Beginning in the mid-1980s, there was a reconsideration of the previous rejection of opioid therapy for non-malignant pain. Encouraging clinical experience with chronic opioid administration to cancer patients and to methadone-maintained addicts dispelled fears of this therapeutic modality and led to refinements in terminology that distinguished physical dependence (provocation of an abstinence syndrome upon discontinuation) and tolerance (increased dose required to maintain physiological effects) from addiction (compulsive use for non-medical purpose despite harm).

Early research indicated that patients without a prior history of addiction ran little risk of becoming addicted through pain treatment with opioids. A small pilot study in 1990 suggested that addicts with chronic pain could be safely treated and that treatment diminished illicit drug use and improved functional status.

In 1997, the American Society of Addiction Medicine affirmed that physicians are obligated to relieve pain and suffering in their patients, including those with concurrent addictive disorders. A study published in 1998 reviewing the relationship between the prescription of opioid analgesics and indicators of drug abuse from 1990 to 1996 concluded that while opioid prescription had increased substantially, opioid abuse represented a declining proportion of drug abuse during this period.

The acceptance by professional bodies of opioid therapy for chronic, non-malignant pain continued throughout the 1990s, as indicated by the passage of Intractable Pain Acts in a number of states, the approval by the American Pain Society and the American Academy of Pain Medicine of The Use of Opioids for the Treatment of Chronic Pain: A consensus statement from American Academy of Pain Medicine and American Pain Society in 1996, and the adoption by the Federation of State Medical Boards of Model Guidelines for Regulating the Use of Controlled Substances in the Treatment of Pain in May, 1998.

In spite of the increasing expert support for opioid therapy, physicians have received mixed signals regarding the acceptability of this treatment. Over the last few years public attention has been focused on OxyContin® (sustained release oxycodone) with stories of overdose deaths, pharmacy robberies, and allegedly corrupt doctors. State medical boards have not uniformly accepted expert professional opinion. But a more ominous development is the increasing pace of state and federal criminal prosecution of physicians engaged in pain practice. Examples include Drs. Frank Fisher, James Graves, Denis Deonarine, Randolph Lievertz, and Cecil Knox.

This is apparently part of a federally coordinated strategy to stop the diversion of OxyContin and other prescription medications at the source–by targeting doctors whose practices focus on medical pain management.

This strategy, however, appears to contradict the stated policy of the Drug Enforcement Administration (DEA) that preventing drug abuse "should not hinder patients' ability to receive the care they need and deserve." In his talk before the American Pain Society on March 14, 2002, Asa Hutchinson, the Director of the DEA elaborated on this position as follows:

I'm here to tell you that we trust your judgment. You know your patients. The DEA does not intend to play the role of doctor. Only a physician has the information and knowledge necessary to decide what is appropriate for the management of pain in a particular situation. The DEA is not here to dictate that to you. We do not intend to restrict legitimate use of OxyContin or other similar drugs. We will not prevent practitioners acting in the usual course of their medical practice from prescribing OxyContin for patients with legitimate medical needs. We never want to deny deserving patients access to drugs that relieve suffering and improve the quality of life.

For the opportunaty to read the rest of this article and to see his sources, log onto Dr. Hurwitz's site at: www.drhurwitz.com.

Unfortunately he is just one of many who now offer this goodbye:

Dear Patients,

I wish you all the best of health, happiness, and good fortune in the coming year. I am grateful for the support and appreciation that many of you have expressed, and look forward to hearing from you.

My office is now closed. I will continue to try to provide medical records and other administrative support. Please e-mail or fax any requests.

With warmest regards,

Doctor Hurwitz

He kindly offers an extended letter with options for those who no longer have access to his pain services. If this has occurred to you, consider seeing if some of his options are useful.

I post this small excerpt to help prevent the loss of more physicians like Dr. Hurwitz, since once the "unicorns" and "Atlantis" is gone, my experience is they never come back.


Dr. J

PS -- the September arrest of northern Virginia's Dr. William Hurwitz -- a respected if controversial pioneer in high -- dosage pain treatment—galvanized opposition among physicians and patients to the DEA's harsh approach. Hurwitz, a leading specialist in his field, was arrested on federal drug-trafficking charges, accused of prescribing excessive quantities of OxyContin to addicts who he knew were selling the drugs on the street. The 49-count indictment alleges that his prescribing practices led to the death of three patients and bodily harm to two others. Federal prosecutors have depicted Hurwitz, a contentious figure who has had his license suspended three times by medical boards, as no better than "a street-corner crack dealer . . . who dispensed misery and death." After initially being threatened with the death penalty, Hurwitz now faces life in prison.

But others defend the doctor. "Dr. Hurwitz saved my husband's life," says Siobhan Reynolds, founder of the Pain Relief Network, a New York City-based grassroots organization defending pain doctors and their patients. For over a decade, Reynolds's husband has suffered terrible head pain caused by a connective-tissue disorder. "Other doctors treated my husband like a leper. If it weren't for Dr. Hurwitz, he would have killed himself. Dr. Hurwitz is responsible for every day that my son has a father."

After the arrest, the Association of American Physicians and Surgeons condemned the prosecution at a news conference held at the National Press Club in Washington, D.C., saying that doctors who treat pain patients are heroes, not felons. A major protest on the National Mall is being organized by the National Pain Patients Coalition for next April to bring attention to what some experts regard as the No. 1 health issue in America: the under-treatment of chronic pain. And a push is on in various states to get politicians to pass bills guaranteeing patients' right to opioids to alleviate their suffering, if a doctor deems it necessary.

Source of above update is an exerpt from: The DEA's War on Pain Doctors, by Frank Owen

November 5 - 11, 2003 in The Village Voice

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