Pubdate: Thu, 7 Sep 2006
Source: USA Today (US)
Copyright: 2006 USA TODAY, a division of Gannett Co. Inc
Contact:  http://www.usatoday.com/printedition/news/index.htm
Details: http://www.mapinc.org/media/466
Author: Donna Leinwand, USA TODAY
Note: Details about the DEA policy statement are at 
http://www.managingpain.org/dea0906.htm
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)

DEA TO CHANGE RULES ON ADDICTIVE PRESCRIPTIONS

Agency to Allow 90-Day Supplies of Painkillers and Other Drugs

Patients who use powerful narcotic painkillers such as OxyContin or 
hyperactivity drugs such as Ritalin will be able to get up to a 
90-day supply of the drugs, rather then just a one-month supply, 
under a rule proposed Wednesday by the Drug Enforcement Administration.

The DEA also issued a statement aimed at assuring doctors that the 
agency doesn't intend to use the Controlled Substances Act -- which 
governs the distribution of highly addictive medicines -- to 
interfere in legitimate treatments of patients with persistent pain. 
The 90-day rule is scheduled to take effect after a two-month period 
in which citizens may submit comments on it.

The changes come at a time when government efforts to halt the abuse 
of prescription drugs have fueled concerns that doctors who 
prescribed large doses of the drugs to treat acute pain would face 
DEA investigations.

The new policy statement does not include a specific list of do's and 
don'ts, but DEA Administrator Karen Tandy says doctors should be able 
to glean from the listing of prosecutions on the agency's website 
what it takes to violate the law.

Out of more than 1 million doctors who are registered with the DEA to 
prescribe such narcotics, the agency prosecuted 67 last year for 
prescription abuse. Tandy says the DEA has targeted doctors who 
strayed far outside accepted medical practice, including some who 
prescribed medically unnecessary drugs for cash or sex, some who 
demanded kickbacks and some who invented patients or fed their own addictions.

The DEA investigates doctors "who knowingly and egregiously put drugs 
into the hands of traffickers and abusers," Tandy says. "This isn't 
just questionable behavior. There is no gray area here."

OxyContin and other powerful narcotics are Schedule II narcotics, the 
most regulated category of prescription drugs because they are highly 
addictive and prone to abuse. Prescriptions of the drugs cannot be 
refilled without an office visit and physical examination by a 
doctor. States may also place additional restrictions on prescriptions.

For years, doctors who treated people with chronic conditions have 
worked around the one-month limit on prescriptions by writing one 
prescription for a three-month supply, and instructing pharmacists to 
dispense only 30 days' worth at a time.

Two years ago, the DEA, working with a committee of doctors, issued 
guidelines that acknowledged the practice and gave advice about 
prescribing the drugs within the law. Several months later, the DEA 
abruptly withdrew the guidelines, saying it had gone beyond its legal 
authority. It replaced them with a statement that reversed a policy 
that allowed multiple prescriptions to be written on the same day.

"It was quite threatening in tone," says Russell Portenoy. Chairman 
of the Department of Pain Medicine and Palliative Care at Beth Israel 
Medical Center in New York City, he helped write the 2004 guidelines. 
"There was a tremendous chilling between the DEA and the medical community."

Since then, pain doctors say the legal questions over Schedule II 
drugs have made physicians more cautious about prescribing them and 
may have hindered effort to treat patients' pain.

Portenoy and other doctors welcome the DEA's move in favor of 90-day 
prescriptions. "This is a step forward," says Frederick Burgess, 
president of the American Academy of Pain Medicine and an 
anesthesiologist at Rhode Island Hospital in Providence. "Doctors who 
are practicing in good faith have very little to worry about."

The use of narcotic pain relievers has increased dramatically in the 
past decade. OxyContin, an opioid introduced in the mid-1990s, 
rapidly became a favorite among patients with severe pain -- and 
among drug abusers.

About 6 million Americans abuse prescription drugs, according to the 
2004 National Survey of Drug Use and Health. The survey also found 
that one in 10 high school seniors said they had used Vicodin, a 
Schedule III narcotic, for non-medical purposes. Schedule III drugs 
have a lower risk of abuse than Schedule II drugs. The 2005 survey 
will be released today.

Tandy says she doesn't want to tell doctors how to treat patients. 
"The DEA does not belong in the practice of medicine. We want doctors 
to be able to prescribe drugs when people are in pain. We're trying 
to give them a comfort level." 
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