Twenty-four years after Darlene broke her back in a swimming pool accident, crippling pain still rules every aspect of her life, from getting up in the morning (which she describes as akin to "climbing the highest mountain") to falling into a fitful sleep at night. After years of botched surgery that left her in even more agony, she knows there is no real cure for what ails her, but thanks to synthetic opioids (which include such regulated substances as Vicodin, Dilaudid, and the devil drug of the moment, OxyContin), she says that she can now lead a halfway normal life. Just folding sheets or washing dishes or sitting at the computer are daily miracles for Darlene, who claims she would otherwise be bedridden and suicidal without the chemical crutches that high doses of these powerful opium-like painkillers provide.
illustration: Viktor Koen
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But in some ways worse than the pain, says Darlene (who doesn't want her last name revealed), are the shame and fear that come with it. Shame when she goes to have her special triplicate prescription—required for all scheduled drugs—filled at the drugstore and the pharmacist looks at her as if she were some addict abusing the drug to get high. Fear that her medications will soon be taken away by the Drug Enforcement Administration's ongoing crackdown on pain doctors. "You worry every day that the medicine won't be available for much longer, or your doctor won't be there tomorrow because he's been arrested by the DEA," she claims. All the bad publicity in the press about the abuse of OxyContin by celebrities such as Rush Limbaugh and Courtney Love doesn't help matters. But, says Darlene, the media scare stories shouldn't blind people to the fact that these drugs—when taken under medical supervision—have made life livable for hundreds of thousands of chronic pain patients, herself included.
Some in the medical community call it "a war on pain doctors," others "a government jihad" or "state-sponsored terrorism." However you describe the current campaign, which according to pain-patient advocates began under Janet Reno, but which they say has increased in intensity under John Ashcroft, the DEA's hardball tactics—storming clinics in SWAT-style gear, ransacking offices, and hauling off doctors in handcuffs—have scared physicians nationwide to the extent that legitimate pain sufferers now find it increasingly difficult to get the medicine they need. Doctors' offices today display signs that say "Don't ask for OxyContin" or "No OxyContin prescribed here." And medical schools advise students not to choose pain management as a career because the field is too fraught with potential legal dangers.
"The war on drugs has turned into a war on doctors and pain patients," says Dr. Ronald Myers, president of the American Pain Institute and a Baptist minister who operates a string of clinics for poor people in the Mississippi Delta. "Such is the climate of fear across the medical community that for every doctor who has his license yanked by the DEA, there are a hundred doctors scared to prescribe proper pain medication for fear of going to prison. The DEA is creating a situation where legitimate pain patients now have to go to the streets to get their medication. It's a health care catastrophe in the making." (Myers theorizes that Rush Limbaugh is probably "a neglected pain patient" and another victim of the crackdown: "Why else would someone with all his money have to go to the street to get enough medication, other than if he couldn't find a doctor to give him an adequate supply?")
Advocates for pain doctors and their patients have had enough. Limbaugh's recent admission that he's addicted to OxyContin and other painkillers has brought the issue of pain management and the law to the fore in the media. But the September arrest of northern Virginia's Dr. William Hurwitz—a respected if controversial pioneer in high-dosage pain treatment—galvanized opposition among physicians and patients to the DEA's harsh approach. Hurwitz, a leading specialist in his field, was arrested on federal drug-trafficking charges, accused of prescribing excessive quantities of OxyContin to addicts who he knew were selling the drugs on the street. The 49-count indictment alleges that his prescribing practices led to the death of three patients and bodily harm to two others. Federal prosecutors have depicted Hurwitz, a contentious figure who has had his license suspended three times by medical boards, as no better than "a street-corner crack dealer . . . who dispensed misery and death." After initially being threatened with the death penalty, Hurwitz now faces life in prison.
But others defend the doctor. "Dr. Hurwitz saved my husband's life," says Siobhan Reynolds, founder of the Pain Relief Network, a New York City-based grassroots organization defending pain doctors and their patients. For over a decade, Reynolds's husband has suffered terrible head pain caused by a connective-tissue disorder. "Other doctors treated my husband like a leper. If it weren't for Dr. Hurwitz, he would have killed himself. Dr. Hurwitz is responsible for every day that my son has a father."
After the arrest, the Association of American Physicians and Surgeons condemned the prosecution at a news conference held at the National Press Club in Washington, D.C., saying that doctors who treat pain patients are heroes, not felons. A major protest on the National Mall is being organized by the National Pain Patients Coalition for next April to bring attention to what some experts regard as the No. 1 health issue in America: the under-treatment of chronic pain. And a push is on in various states to get politicians to pass bills guaranteeing patients' right to opioids to alleviate their suffering, if a doctor deems it necessary.
