In an "Interim Policy Statement" published today in the Federal Register, the DEA offers a partial explanation for its decision to withdraw a pamphlet that gave doctors advice about prescribing narcotic painkillers. Advocates for pain patients and their doctors had speculated that the pamphlet was pulled because it provided support for the arguments of physicians (such as William Hurwitz) who complain that the government is unjustly prosecuting them for prescribing narcotics in good faith. But the official explanation was that the DEA had discovered several "misstatements" in the pamphlet, which was a product of extensive collaboration between the agency and leading pain experts. In today's Federal Register entry, the DEA identifies several of these problematic passages:
Pamphlet: "The number of patients in a practice who receive opioids, the number of tablets prescribed for each patient, and the duration of therapy with these drugs do not, by themselves, indicate a problem, and they should not be used as the sole basis for an investigation by regulators or law enforcement."
DEA Rebuttal: We reserve the right to investigate anybody whenever we want, even if it's just to make sure that he's not breaking the law.
Pamphlet: "Schedule II prescriptions may not be refilled; however, a physician may prepare multiple prescriptions on the same day with instructions to fill on different dates."
DEA Rebuttal: No, he may not. Don't even think about it.
Pamphlet: "Red flags" suggesting that a patient might be misusing or selling prescibed opioids "should not be taken to mean that a patient does not have pain, or that opioid therapy is contraindicated."
DEA Rebuttal: The pamphlet "understated the degree of caution that a physician must exercise to minimize the likelihood of diversion when dispensing controlled substances to known or suspected addicts."
Pamphlet: "Family and friends, or health care providers who are not directly involved in the therapy, may express concerns about the use of opioids. These concerns may result from a poor understanding of the role of this therapy in pain management or from an unfounded fear of addiction; they may be exacerbated by widespread, sometimes inaccurate media coverage about abuse of opioid pain medications."
DEA Rebuttal: "The above-quoted statement is incorrect to the extent it implies that physicians may simply disregard such concerns expressed to them by family members or friends. Indeed, a family member or friend might be aware of information that the physician does not possess regarding a patient's drug abuse."
In short, while the ostensible message of the pamphlet was that doctors who prescribe painkillers in good faith needn't worry about getting into trouble with the government, the message of the DEA's retraction is that they can't worry too much.
[Thanks to Ryan Singel for the tip.]