In a pamphlet released last August, the Drug Enforcement Administration (DEA) attempted to reassure doctors who worry that prescribing narcotics could attract unwanted attention from the government. Among other things, the agency acknowledged that "simple exposure to opiods" is not enough to produce addiction; that "any physician can be duped" by people seeking opioids for nonmedical reasons; that "pseudoaddiction," the undertreated pain patient's superficial resemblance to an addict, "greatly complicates the assessment of drug-related problems"; and that "the parameters of acceptable medical practice include patterns of drug prescription...that may raise a 'red flag' for both clinicians and regulators."
Doctors fighting the "opiophobia" that leads to widespread undertreatment of pain have been making such points for many years. But it was surprising to see them endorsed by the DEA, which has long insisted there is no conflict between drug control and pain control.
Although such concessions may have fed the fears the pamphlet was supposed to assuage, they also reinforced the arguments of doctors who say they've been unjustly prosecuted for prescribing narcotics in good faith. (See "Dr. Feelscared," August/September.) That may explain why the DEA removed the guidelines from its Web site two months after posting them, ostensibly because of unspecified "misstatements." The pamphlet, which was the product of extensive collaboration between the DEA and leading pain experts, bore the DEA's logo, and its publication was announced by a top official of the agency's Office of Diversion Control. Yet when it withdrew the guidelines, the DEA insisted "the document was not approved as an official statement of the agency and did not and does not have the force and effect of law."
The DEA pulled the pamphlet a few weeks after defense attorneys for McLean, Virginia, pain doctor William Hurwitz sought to introduce it as evidence in his federal trial on drug trafficking charges. "It seems pretty clear that they felt they had to try to get rid of the guidelines because they supported so many parts of our case," Hurwitz attorney Patrick Hallinan told The Washington Post. "If the Justice Department followed the guidelines, there would be no reason to arrest and charge Dr. Hurwitz."�