DEA'S OPIOID POLICY DISCUSSED

Doctors avoid prescribing narcotic painkillers to people who need
them because they are afraid of being investigated by the federal
government, the head of a Billings pain clinic said Friday.

"Many physicians avoid opioids, and that has caused millions of
Americans pain," said Dr. John Oakley, medical director of the
Northern Rockies Regional Pain Center. "The ability to discern who is
an addict and who is not an addict is difficult to do, and treating
an addict can be seen as a violation of the law. ... Definitions are
sometimes unclear. Definitions can be seen as threatening."

Oakley estimated that 80 percent of physicians do not prescribe
opioids, the medical term for narcotics, for fear of being
investigated by the Drug Enforcement Administration. Javascript
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He called the regulations surrounding the legal dispensation of
powerful painkillers "a morass that changes almost yearly" and said
doctors are often uncertain what is legitimate and what is not.

Oakley spoke during a symposium about chronic-pain management held at
St. Vincent Healthcare for law enforcement, medical providers,
educators and others.

Using opioids to manage chronic pain has been debated in the medical
community for decades, but recently the conversation erupted into controversy.

Oakley said that was due in part to "an aggressive plan to eradicate
diversion of OxyContin" launched by the DEA after media reports about
abuse of the narcotic painkiller were blown out of proportion.

The DEA was pressured by the U.S. Department of Justice to respond to
the perceived problem, he said.

"Many reports were exaggerated or unfounded," he said.

Diversion occurs when legal drugs are used illegally, such as when
prescription painkillers are sold on the street.

Since the DEA began investigating doctors, including one in Billings,
a chill has been cast on the doctor-patient relationship, and some
patients in pain are not receiving adequate care, Oakley said.

The DEA opened an investigation of Richard A. Nelson, a Billings
neurologist who treated chronic-pain patients with opioids, several
months ago. Nelson's prescription-writing privileges were suspended,
and many of his patients claimed they could not find other physicians
to treat them.

A DEA spokesman said on Friday that no criminal charges have been
filed against Nelson, and the investigation into his medical practice
continues. He remains in good standing with the state Board of
Medical Examiners.

At the Northern Rockies Regional Pain Center, patients treated with
opioids are closely monitored for signs of abuse or diversion, said
Dr. Michael Schabacker.

To receive opioids, patients must sign a contract and consent to
regular urine tests, Schabacker said. The tests help physicians
determine whether patients are taking the drugs prescribed to them
and whether they are taking them as instructed.

"Absence of the drug in urine is a sign of diversion," he said.
"Unsuspecting chronic-pain patients have had family and friends
emptying their pill bottles as soon as they got home and putting
other tablets in there."

Most patients at the pain center are happy to provide urine samples, he said.

"A lot of patients with chronic pain have a lot of concern about how
they're viewed. They feel the need and use of these opiate
medications is in some way unsavory," Schabacker said. "People are
anxious and oftentimes offer to provide their screening."

Patients who show signs of addiction are referred to
chemical-dependency programs, but many sever their relationship with
the pain center rather than submit to an evaluation.

Addiction to prescription painkillers is estimated to occur in 3
percent to 20 percent of people who use them.

[Sidebar]

Addicted, Dependent Or Tolerant

Not everyone who uses opioids, or narcotic painkillers, becomes addicted them.

Someone who is addicted will continue to use a drug despite being
harmed by it. Harm can include things such as losing a job or
neglecting a child.

Physical dependence on a drug is not the same as addiction. A person
who is physically dependent experiences withdrawals when he or she
stops taking a drug but is not harmed by it when it is taken as directed.

Tolerance also is not addiction. Tolerance occurs when a person's
body builds up resistance to the effects of a drug. Tolerance
develops over time and is common among people who take opioids to
manage chronic pain for long a long time.