Rush Limbaugh, the darlin' of right-wing radio and the "lock 'em up and throw away the key" crowd, once said, in response to the criticism that we prosecute a disproportionate number of African-Americans on drug crimes, that we should "find" and send "up the river" white drug users, too. Now, since allegations have surfaced that he illegally procured a substantial supply of the painkiller OxyContin, he appears to have changed his tune. "Treatment" has suddenly entered his vocabulary and he has taken a leave from his popular radio show to attend detox.
Someone send this guy a pair of Birkenstocks, a foxhole conversion is under way.
Beyond the damage Limbaugh has done to his highly burnished conservative credentials, his sensational fall has added to the woes of another group: those in chronic pain who rely on OxyContin to relieve their torment. This kind of adverse publicity will only make it harder for patients to get access to the pain medication they need.
As chair of the Department of Pain Medicine at Presbyterian Hospital in Charlotte, N.C., and past president of the American Academy of Pain Medicine, Dr. Gerald Aronoff has seen the way hysterical news accounts of OxyContin as the "new crack" have resulted in more limited access. He says every high-profile story about how OxyContin or other pain medication has addicted some public figure makes physicians even more skittish about prescribing what is needed to control very real pain.
"My legitimate chronic pain patients don't have medical problems related to OxyContin. They get therapeutic benefit from these medications," Aronoff says. "The people who are using it to get high are not taking the medication as it was meant to be taken based on the pharmaceutical recommendations."
But doctors who prescribe heavy doses of OxyContin to a large number of patients risk drawing the attention of the Drug Enforcement Administration and state medical boards. For patients, this means doctors are less ready to provide them relief.
Skip Baker, a longtime pain activist, says he has heard from thousands of pain patients who couldn't find a physician willing to prescribe OxyContin in the needed doses. According to Baker, his own doctor "quit treating pain patients entirely" due to his fear over potential law enforcement action.
But OxyContin is not some evil chemical street brew. It was brought to market by Purdue Pharma in 1995 and is a synthetic opioid, just like Percocet and Percodan, except it is time-released over 12 hours. The long-term relief allows many patients with otherwise debilitating pain to return to almost normal functioning. For many, it is life-changing.
Abuses occur when people defeat the time-release by chewing the tablets or through injection, resulting in what is described as a heroinlike high.
Last year, Florida doctor James Graves became the first physician in the nation to be convicted of manslaughter for prescribing the drug. He was given a 63-year prison sentence after four of his patients died from overdosing on OxyContin. He argued that his patients would not have died had they taken the medication as prescribed. But prosecutors said his practice was really just a front for drug dealing.
The particulars of Graves' case aside, to my mind, prosecuting doctors when their patients overdose is like jailing gun dealers when a firearm they sold is used to kill someone. The culpability is misplaced. Individuals have personal responsibility for what they ingest, not the doctor who supplied a lawful product to someone who claimed to be ailing.
It is one thing if a doctor's office is truly a glorified drug market. It is quite another when a doctor is being lied to by a handful of his or her patients about the level of pain being experienced and whether the drugs they get are being used as prescribed. No doctor should automatically fall under suspicion in those circumstances, even when overdose deaths occur.
Here, the story of a Virginia pain specialist, Dr. William Hurwitz, comes to mind. Hurwitz was hounded out of medicine by the nation's drug warriors. In 1996, his medical license was suspended after the DEA accused him of overprescribing OxyContin. Only after dozens of patients and pain experts rallied to his defense was it reinstated. But Hurwitz nonetheless left his practice last year. Again he found he was being investigated by the DEA.
In his goodbye letter to patients and colleagues he wrote about the trend in prosecuting pain doctors: "I have discovered that neither the honesty nor the competence of the physician is any substantial protection against prosecution, as the investigating and prosecuting officials neither know or care about the accepted principles of treatment for chronic intractable pain."
Reputable physicians need some kind of safe harbor from this kind of harassment. Limbaugh may not have known when to say when, but that shouldn't condemn thousands of others with debilitating pain to a life of suffering because doctors are too scared of the DEA to minister properly.