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Dr. Heit provides an excellent
summary of the events that constitute the history of the attempt to create
balance—curbing diversion while simultaneously protecting access to pain
medicines. It is, unfortunately, a sad story. Going from the optimism after
producing and disseminating Prescription Pain Medications: Frequently Asked
Questions and Answers (FAQ), to the disappointment of the abrupt withdrawal of
the same document with subsequent "clarifications" that reflected a significant
retreat from the goal of protecting access to pain medicines for people who need
them, the story's current ending has many, many victims—people affected by pain.
[Healthcare
Professionals and the DEA: Trying to Get Back in Balance;
Heit; 2006]
From the perspective of the pain patient, things have gotten worse. It is harder
to get prescriptions for Schedule II pain medicines because prescribers are even
more reluctant to prescribe. They are reluctant because they are not clear what
is acceptable and what is not acceptable, and it is safer to avoid any
opportunity for confusion. Also, things are worse because the long understood
method of writing prescriptions had been changed by not allowing a prescriber to
prepare multiple prescriptions on the same day with instructions to fill on
different dates. Dr. Heit concludes that "the spirit of cooperation that existed
between the DEA and the pain community to achieve the goal of balance has broken
down."
The rise of the abuse and diversion of prescription medicines has precipitated a
loud demand from the President on down to stop the abuse of prescription
medicines. This command, siloed as it is in the Department of Justice, is
seriously flawed. It is flawed the same way that it is wrong to curb the rise of
parking problems by banning the use of cars on weekends. You are guaranteed to
have fewer parking problems, but you will have prohibited access to cars to a
great number of people who need and deserve the use of their cars. The correct
command should read: stop the abuse and diversion of prescription medicines
without harming access to these medicines for people affected by pain. That
command is not directing the activities of the Drug Enforcement Administration
(DEA). If it were they would not be arresting doctors at the rate occurring
today around the country; they would not have withdrawn the FAQ; they would not
agree to be in a veto position to newly approved Food and Drug Administration
medicines; they would not have virtually withdrawn from the dialogue about
achieving balance.
The failure here is in the DEA not abiding by its commitment to the pain
community to pursue balance. It is also the failure of those in authority over
the DEA to assert the more comprehensive command. This is not a simple law
enforcement issue. The needs and rights of millions of pain patients are
neglected in the abbreviated command. To those who authorize the DEA, surely if
it was your mother, partner, or friends who could not get the medicine they need
because of the practice of law enforcement, you would insist that law
enforcement measures not trample the needs and rights of those requiring these
medicines to live normal lives.
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