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Executive Summary
The medical field of treating chronic pain is still in its infancy. It was only
in the late 1980s that leading physicians trained in treating the chronic pain
of terminally ill cancer patients began to recommend that the "opioid therapy"
(treatment involving narcotics related to opium) used on their patients also be
used for patients suffering from nonterminal conditions. The new therapies
proved successful, and prescription pain medications saw a huge leap in sales
throughout the 1990s. But opioid therapy has always been controversial. The
habit-forming nature of some prescription pain medications made many physicians,
medical boards, and law enforcement officials wary of their use in treating
acute pain in nonterminal patients. Consequently, many physicians and pain
specialists have shied away from opioid treatment, causing millions of Americans
to suffer from chronic pain even as therapies were available to treat it.
The problem was exacerbated when the media began reporting that the popular
narcotic pain medication OxyContin was finding its way to the black market for
illicit drugs, resulting in an outbreak of related crime, overdoses, and deaths.
Though many of those reports proved to be exaggerated or unfounded, critics in
Congress and the Department of Justice scolded the U.S. Drug Enforcement
Administration for the alleged pervasiveness of OxyContin abuse.
The DEA responded with an aggressive plan to eradicate the illegal use or
"diversion" of OxyContin. The plan uses familiar law enforcement methods from
the War on Drugs, such as aggressive undercover investigation, asset forfeiture,
and informers. The DEA’s painkiller campaign has cast a chill over the
doctor-patient candor necessary for successful treatment. It has resulted in the
pursuit and prosecution of well meaning doctors. It has also scared many doctors
out of pain management altogether, and likely persuaded others not to enter it,
thus worsening the already widespread problem of undertreated or untreated
chronic pain.
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