It has been about ten years since the United States Drug Enforcement Administration (DEA) launched what some feel is a targeted war on
drugs, the battleground being your Doctor's office. The DEA feels there has continued to be a diversion of prescription narcotics for use on "the street"-but it is not clear they were referring to Main Street. Although, these days I am sure that our friends on Wall Street could use some sort of street drug.
The focus on physicians is perhaps the least resistant path to the easier drug bust: After all, physicians are supposed to maintain records of prescriptions written, and document the reasoning behind and the plans for the continued use of a prescription drug. That drug dealer picking his toes in Poughkeepsie is a tougher collar; no Electronic Medical Record for him.
Some unfortunate physicians have been put through the wringer of the American judicial system, on charges ranging from drug dealing to murder, charges rooted in charges of the over-prescribing of narcotic medications. There is a certain irony here, as such woes have befallen physicians in parallel with the development of drugs which have allowed significant relief for those sufferers of chronic pain. For example, the development of so-called opioids has certainly helped the millions with chronic pain, and by some accounts only leading to addiction in less than one percent.
Nevertheless, in the minds of many there has been a consequent mood among physicians, which can depending on the day of the week range from hesitant to paranoid, and which has stifled the prescribing of drugs in even those end-of-life cases where pain can become a cloud which hangs over every dwindling minute of the terminal patient.
A couple of years ago, the DEA agreed that perhaps it had gone too far in restricting physicians' prescribing habits, and began to allow physicians to prescribe multiple prescriptions in a single office visit. But chronic pain patient advocates still feel that there is too much oversight by the DEA. Physicians are still being monitored, which is not surprising if one considers the sharp rise in the utilization of prescription narcotics over the past decade. Many physicians simply refuse to prescribe narcotic medications.
And so it follows that there is a perception in this country that prescription narcotics are a "bad" thing for the patient, no matter the stage of life or the degree of suffering. The result is that there are many patients who are living with inadequately controlled pain, and dying with the same.
Hopefully, there is a sea change in the way prescription narcotics are viewed. Better yet, hopefully there are new drugs which will allow narcotics to be an unnecessary relic from the dark ages of medical history.
In the meantime, the doctor-patient relationship will continue to have the DEA as the 800-pound gorilla in the waiting room, a curious cross between judge and advocate, whose very presence begs all involved to beg penitence. And the chronic pain patient just suffers.
