There are a number of doctors who prescribe a high volume of commonly abused pain medications, sometimes to clients who turn around and sell the pills on the street. It is the responsibility of the Drug Enforcement Agency to stop flagrantly illegal behavior. Clinics run by such doctors are called “pill mills”.
People seek pain relief for all sorts of conditions and as individuals may have different levels of pain tolerance. Someone who is on a particular medication for awhile may need to have the dosage increased because their body gets used to it. Certain medications may also cause chemical dependency.
Judging how much pain medication a patient needs is a fundamental part of a physician’s job, and that decision should be free from interference by the government. Unfortunately, should someone at the DEA decide that you, as a doctor, are prescribing too much medication to a patient, you will face arrest, fines, loss of license, and imprisonment. The overzealous attitude of those in government are creating the conditions today in which patients suffering from chronic pain are routinely under medicated.
The problem is not limited to the DEA. Local prosecutors working for the Department of Justice are the ones actively pursuing these cases, even though it doesn’t make any sense. Harry A. Silverglate writes in Forbes about a particularly egregious case:
The current contretemps in Wichita has its roots in 2002 when Sean Greenwood, who for more than a decade suffered from a rare but debilitating connective tissue disorder, finally found a remedy. William Hurwitz, a Virginia doctor, prescribed the high doses of pain relief medicine necessary for Greenwood to be able to function day-to-day.
Shortly thereafter, Dr. Hurwitz was arrested and shut down by federal agents. Greenwood couldn’t find any other doctor willing to risk the wrath of the DEA, so he suffered for 3 years before dying. High blood pressure, caused by years of untreated pain, was likely a strong factor in his untimely death.
Improprieties galore marked the prosecution of Dr. Hurwitz. Before his trial in federal court in Virginia in 2004, the DEA published a “Frequently Asked Questions” (FAQ) pamphlet for prescription pain medications. In a remarkable admission, the DEA wrote that confusion over dependence and addiction “can lead to inappropriate targeting of practitioners and patients for investigation and prosecution.” Yet on the eve trial, the DEA, realizing that Hurwitz could rely on this government-published pamphlet to defend his treatment methods, withdrew the FAQ from its Web site. Winning the case proved more important than facilitating sound medical practice. Hurwitz was convicted.
Sadly, Dr. Hurwitz is not alone, and his case is not nearly the most egregious.
The litany of abusive prosecutorial tactics could fill a volume. A “win-at-all-costs” mentality dominates federal prosecutors and drug agents involved in these cases. After a Miami Beach doctor was acquitted of 141 counts of illegally prescribing pain medication in March 2009, federal district court Judge Alan Gold rebuked the prosecution for introducing government informants–former patients of the doctor who were cooperating to avoid their own prosecution–as impartial witnesses at trial.
Greenwood’s wife, Siobhan Reynolds, decided to do something about a situation she saw as outrageous.
In 2003 she founded the Pain Relief Network (PRN), a group of activists, doctors and patients who oppose the federal government’s tyranny over pain relief specialists.
Somehow, the arrogant fools in power decided that having a concerned citizen shed light on their abusive practices is a bad thing to be stopped.
Now, the PRN’s campaign to raise public awareness of pain-doctor prosecutions has made Reynolds herself the target of drug warriors. Prosecutors in Wichita have asked a federal grand jury to decide whether Reynolds engaged in “obstruction of justice” for her role in seeking to create public awareness, and to otherwise assist the defense, in an ongoing prosecution of Kansas pain relief providers. The feds’ message is clear: In the pursuit of pain doctors, private citizen-activists–not just physicians–will be targeted.
An attorney for the government should know better than to try and squash op-ed pieces. Even if it were Reynolds opinion that everyone in the United States should get cases of whatever pain pills they desire for no particular reason, it is still her 1st Amendment protected right to express her opinion.
In Kansas, it appears that zealous prosecutors are targeting not only the doctors, but also their public advocates. When Reynolds wrote op-eds in local newspapers and granted interviews to other media outlets, Assistant U.S. Attorney Tanya Treadway attempted to impose a gag order on her public advocacy. The district judge correctly denied this extraordinary request.
Having learned nothing up until this point, Treadway is still going in for the kill with a new subpoena.
“Obstruction of justice” is the subpoena’s listed offense being investigated, but some of the requested records could, in no possible way, prove such a crime. The prosecutor has demanded copies of an ominous-sounding “movie,” which, in reality, is a PRN-produced documentary showing the plight of pain physicians. Also requested were records relating to a billboard Reynolds paid to have erected over a busy Wichita highway. It read: “Dr. Schneider never killed anyone.” Suddenly, a rather ordinary exercise in free speech and political activism became evidence of an obstruction of justice.
On Sept. 3, a federal judge will decide whether to enforce this subpoena, which Reynolds’ lawyers have sought to invalidate on free speech and other grounds. The citizen’s liberty to loudly and publicly oppose the drug warriors’ long-running reign of terror on the medical profession and its patients should not be in question. Rather, the question should be how the federal government has managed to accumulate the power to punish doctors who, in good faith, are attempting to alleviate excruciating pain in their patients.
Harvey A. Silverglate is the author of Three Felonies A Day: How The Feds Target The Innocent. Glenn Reynolds writes about it here:
Some years ago I started on a project entitled Due Process When Everything Is A Crime. The gist was that since criminal law has expanded to the point where everyone is some sort of a felon, the real action is in the area of prosecutorial discretion — in choosing whom to prosecute from among this population-wide mass of the guilty — where, in fact, due process basically doesn’t apply. That suggests that maybe there should be some due-process limits on decisions to prosecute. I never got to it (my scholarly rangetop has so many back burners it must be a half-mile deep) but the issue continues to deserve attention.