The charges against Deonarine and other deaths involving OxyContin have had a chilling effect on doctors who treat chronic pain patients, according to Dr. Pamela Sutton, a pain management specialist with the North Broward Hospital District. One doctor told Sutton that he would only give the drug to patients in the hospital, while another said he would not prescribe it to anybody.
The problem, of course, is that chronic pain patients tend to develop a tolerance for opioids and so will eventually require enormous doses, which would be consistent with abuse in normal users. So, it's very hard to tell purely from dosage whether appropriate levels of opioids are being prescribed. If the DES is going to second-guess doctors, this is naturally going to make them very unwilling to prescribe high-dose therapy, leaving some patients undertreated.
It probably goes without saying that I think that the whole idea of the DEA second-guessing the opioid prescriptions doctors write--indeed, the whole notion that doctors should be expected to distinguish between drug-seekers and people in genuine pain--is absurd. However, I despair of the United States getting over it's national hysteria over drugs any time soon, so it's time to think about harm reduction.
What we need is some procedure that would let doctors prescribe high doses while being reasonably sure they weren't going to be arrested. The obvious approach is to have some scheme where doctors get prior approval for prescriptions above a certain level, either from the DEA or from some panel of other doctors. Doctors who followed that procedure would be exempt from prosecution resulting from writing those prescriptions. If the DEA is really sincere about allowing appropriate pain therapy while stopping diversion, they should be willing to embrace such a scheme.
