DEA Revises Rule on Prescribing Painkillers

http://www.washingtonpost.com/wp-dyn/content/article/2006/09/06/AR2006090601756.html?referrer=email

DEA Revises Rule on Prescribing Painkillers
Doctors Freed to Write Multiple Prescriptions
By Marc Kaufman
Washington Post Staff Writer
Thursday, September 7, 2006; A04

The Drug Enforcement Administration yesterday
overturned a two-year-old policy that many pain
specialists said was limiting their ability to
properly treat chronically ill patients in need of
powerful, morphine-based painkillers.

While defending its efforts to aggressively
investigate doctors who officials conclude are writing
painkiller prescriptions for no "legitimate medical
purpose," the agency agreed with the protesting
experts that it had gone too far in limiting how
doctors prescribe the widely used medications.

The unusual turnaround was welcomed by relieved
doctors, who said it will help restore "balance" in
government policy between the needs of pain patients
and the effort to control prescription drug abuse and
diversion.

Specifically, the DEA proposed a formal rule that
would allow doctors with patients who need a constant
supply of morphine-based painkillers to write multiple
prescriptions in a single office visit. Under the new
rule, a doctor can write three 30-day prescriptions at
a time -- two of them future-dated -- to be filled a
month apart.

Two years ago, the agency clamped down on the common
practice of writing such multi-month prescriptions,
which it said were probably illegal and were
contributing to the growing abuse of prescription
painkillers.

As a result of the DEA's position, many doctors began
requiring patients to come in each month for a new
prescription -- office visits many doctors considered
medically unnecessary but essential to keep them out
of trouble with the DEA.

Yesterday, DEA Administrator Karen Tandy said the
agency had been wrong in limiting the multiple
prescriptions and had made the tough decision to
reverse course. She said the DEA received more than
600 comments from doctors, patients and others about
its policies on narcotic painkillers, many of them
strongly opposed to the agency's position on limiting
refills.

"Think about how hard it is for anybody to go out
publicly and say, 'We think this is probably
prohibited by law,' " she said, referring to the
earlier decision to prohibit multiple refills. "And
then you listen to people and then you say, 'You know
what? You're right,' and we're going to propose a rule
that interprets this correctly. And that's what we've
done."

When the DEA issued its restrictive 2004 drug refill
guidelines, many pain specialists saw it as a sign
that relations between their profession and the agency
had deteriorated badly. They also complained that DEA
arrests and prosecutions of doctors treating pain were
creating a "chill" on medical practice and denying
patients drugs they needed.

Agency officials had earlier worked for two years with
pain and hospice experts on a "frequently asked
questions" guideline to advise doctors on how to
prescribe controlled drugs in a way that would not get
them into trouble with law enforcement. The agency
briefly posted the guidelines on its Web site in 2004
but then pulled them down and disavowed them.

One of the doctors involved with writing the
guidelines -- who became a critic of the DEA when they
were abruptly discarded -- called Tandy's actions
yesterday "a very positive step forward in restoring
that necessary cooperation between practicing
physicians and the DEA."

Howard Heit, a Fairfax County pain and addiction
specialist, also said the new policy will help
patients get better care by allowing doctors more
flexibility in prescribing controlled drugs.

But Siobhan Reynolds, who created the Pain Relief
Network several years ago to help defend pain doctors
who she said were being unfairly arrested and
prosecuted, disagreed and said the new DEA policy has
changed little.

"Ms. Tandy states here, as she has on many occasions,
that doctors need not fear criminal prosecution as
long as they practice medicine in conformity with what
these drug cops think is 'appropriate,' " Reynolds
said. "If that isn't a threat, it will certainly pass
for one within the thoroughly intimidated medical
community."

The use of prescription narcotics rose sharply over
the past decade as knowledge grew on how to control
intractable pain and specialists found what they
considered better ways to help patients. That growing
use, however, has led to abuse as well, and to scores
of deaths and injuries associated with prescription
narcotics.

In addition to publishing its new policy statement and
rulemaking yesterday, the DEA began posting extensive
information on its Web site about doctors who have
been arrested and prosecuted for their prescribing
practices. Tandy said that she hopes doctors will
review the cases so they will see that only
"egregious" offenders are being prosecuted.

© 2006 The Washington Post Company