DEA Response to War on Pain Medicine

In this week’s show “Hands Off My Meds” (re-airing tonight at 10pm ET, Saturday at 7pm ET, and Sunday at 11pm ET), I ask: Why does the DEA, in its zeal to prosecute the disastrous War on Drugs, frequently harass and prosecute doctors who prescribe pain medicine with opiates—legal medications like oxycontin, vicodin and percocet—to patients with chronic pain?  Ron Libby, a professor of political science at the University of North Florida and author of “The Criminalization of Medicine: America’s War on Doctors,”  says this government crackdown leaves thousands of patients in pain. The Association of American Physicians and Surgeons says this to its members: “If you’re thinking about getting into pain management using opioids as appropriate: DON’T. Forget what you learned in medical school – drug agents [from the DEA] now set medical standards.”

The DEA declined to be interviewed. They sent us this instead:

DEA’s mission is to protect the public health and safety.  In the performance of this mission, DEA targets and investigates those individuals who violate the law, regardless of their profession.  American jurisprudence is deeply rooted on the fundamental principle of equal justice under the law.  Coinciding with this basic principle is another overarching principle – no one is above the law.  When seeking medical care, the American public must be able to trust their doctor.  They have a right to know that their doctor isn’t going to trade prescriptions for sex, file millions of dollars worth of fraudulent insurance or Medicare claims, or be impaired from self abuse of controlled substances while treating patients. Fortunately, the vast majority of doctors are outstanding professionals who truly desire to provide medical care and treatment to patients, to heal.    Doctors who issue controlled substance prescriptions for a legitimate medical purpose in the usual course of professional practice have nothing to fear from the DEA.  But rather than extinguish this fear with facts, Mr. Libby stokes the ambers of fear with false or misleading information that only perpetuates misconceptions and fear.  On average, DEA arrests only 85 doctors annually of the more than 750,000 medical doctors and doctors of osteopathic medicine.   Most DEA investigations of physicians are initiated due to information provided by a medical or pharmacy board, an employee of the doctor, a patient or other law enforcement agency.  More often than not DEA utilizes its regulatory authority rather than its criminal investigative authority to administratively sanction practitioners and other DEA registrants.  If a criminal or civil case is warranted, the determination to prosecute rests with the State or Federal prosecutor.  Mr. Libby, however, believes that is implausible for a doctor to commit a criminal offense or that they should somehow be immune from prosecution.  He further believes that if law enforcement uncovers criminal activity involving a doctor, officials should simply advise the doctor to stop violating the law.  Apparently, he believes that doctors should never be held accountable for their actions.

It is Mr. Libby’s belief that doctors are simply duped into committing criminal offenses.  The facts, however, are quite different.  The doctors investigated by the DEA have committed acts that are far from the mainstream of medical practice.  For example, a doctor in Spring Hill, Florida anesthetized his patient and then attempted to have nonconsensual sex with the patient. Several physicians  were associated with 34 rogue Internet pharmacies in 2006 who dispensed more than 98 million dosage units of controlled substances to patients they never met, examined,  or performed diagnostic tests to make an appropriate diagnosis.  . How about the pain clinic in Florida whose employees had to stage a burglary at the clinic to cover for the thousands of dosage units its doctor doled out as if every day were Halloween or the  doctor in Taylor, MI who falsified and instructed others to falsify patient files; prescribed controlled substances in such combinations that they were likely to cause death; and provided prescriptions for controlled substances to individuals the doctor knew were addicted or who would  sell the drugs illegally.

Mr. Libby has stated on several occasions that he is concerned about the under treatment of pain in the U.S.  He apparently has not visited South Florida lately where there are more than 500 pain clinics in just a three-county area alone.  These clinics advertise that walk-ins are welcome and that there is no waiting.  However, of the top 100 practitioners that dispense oxycodone from their office, 96 of them are in Florida and 86 are in the same three-county area.  The proliferation of pain clinics in one South Florida county has been so great that city and county officials are looking to enact ordinances to ban any new ones from opening.  DEA is statutorily responsible for enforcing the Controlled Substances Act which is designed to prevent and detect the diversion of controlled substances.  In executing its responsibilities, DEA does not enforce the law in a “cafeteria style” - picking and choosing which provisions of law it will enforce and which ones it won’t.

DEA does not target physicians based on their practice specialty or medical conditions that they diagnose and treat.  DEA encourages doctors to treat pain, or any other medical condition, as medically warranted and under the regulations and standards established by the practitioner’s licensing/professional board. DEA does not want to interfere with the legitimate practice of medicine.  DEA routinely meets with medical groups and medical associations to achieve an appropriate balance between the practice of medicine and law enforcement.

Mr. Libby claims that DEA is demonizing pain doctors for practicing medicine.  Ironically, his accusations against DEA seem to demonize legitimate law enforcement.

I find Mr Libby much more convincing than the DEA.