Is It Chilly, or Is It Me?

In a press release issued yesterday, the Drug Enforcement Administration claims it's a "myth" that efforts to prevent diversion of controlled substances have a chilling effect on doctors' prescription practices. "Doctors Operating Within the Bounds of Accepted Medical Practice Have Nothing to Fear From DEA," says the headline. The problem is that doctors have to predict what the DEA will consider to be "accepted medical practice." Does it include, for example, long-term treatment of chronic pain with large doses of opioids?

To demonstrate the absence of a chilling effect from regulatory penalties and prosecutions, the DEA notes that in the first three quarters of fiscal year 2003 it investigated only 0.06 percent of the nearly 1 million doctors who are registered to prescribe controlled substances. That figure does not include investigations by state regulators where no DEA action is taken.

The DEA does not seem to understand what chilling effect means. It's an effect that goes far beyond those directly targeted by the government, including every doctor who has ever worried about arousing suspicion by prescribing the wrong drug to the wrong person in the wrong quantities. Right and wrong in these situations are judged not by what is medically appropriate or what is best for the patient but by what is least likely to attract the government's attention. The safest course is to err on the side of undertreatment, which means treating patients' complaints skeptically and dispensing narcotics grudgingly if at all.

[Thanks to Siobhan Reynolds for the link.]