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Autumn 2005
Journal of the California Cannabis Research Medical Group

Painful Lessons to be Learned From DEA War on Opioid Prescribers

By Joe Talley, M.D.

Many lay people assume that most doctors know and believe that chronic pain should be treated with opioids, but are too fearful of authorities to risk their careers and freedom to do the right thing. This is not really the way it is.

I can tell you that 10 years before the DEA began to target doctors, the vast majority of doctors had already turned their backs on patients in pain and on any of the few doctors who used opioids to treat chronic pain. Pain patients can tell you how, all through the ‘80s and ‘90s they were insulted and ostracized by virtually every family practitioner, nurse, and emergency room physician they met, and the specialists who should have known better (neurologists, psychiatrists, rehab physicians, and yes, even most pain specialists!)

Most doctors do not feel intimidated by the DEA, even today, because they think the DEA is doing right!!! If a doctor goes down, they assume that he was indeed a “bad apple” who deserved it.

The Deering Clinic in Montana is not withholding opioids and/or giving their patients a terrible time because of an intimidating DEA visit. They are just doing what they always did. Had they, and the other doctors and clinics in the area, not long ago turned their backs on patients in pain, no one would have ever heard of Dr. Nelson.

I don’t know the man, but fifty bucks says he did not, as a medical student, decide that pain medicine would be his specialty. I submit that he was like me and many other docs who were pursuing their chosen specialty, but when within that specialty they encountered patients in pain, they read the literature, prescribed the medications like we would for any other disease, observed the results, and continued to treat.

Then one day we discovered we were “pain specialists” for no reason other than none of our colleagues would do what we were doing. Some of these colleagues gave lip service to using opioids to treat “selected patients,” but, as Siobhan Reynolds has observed, none of them ever managed to select any. And the tiny minority who would treat suddenly found an army of everybody else’s patients at their doorstep.

Worse, the majority who would not treat would not give any support to those who did. Or even keep their mouths shut. To justify their own failure to do their duty, they found it necessary to disparage physicians who did.

ER doctors were the world’s worst at this. Several times I had to directly challenge an ER doc who was trashing me and my patients in front of his staff. They would always deny they had done so, of course, but then would continue to do it! It was this sort of thing that began to destroy what had been a sterling reputation I had built for the previous 30 years, and it began to happen long before the DEA shifted their targets to doctors. I will bet that virtually all pain specialists will tell you they saw their own reputation similarly besmirched long before the threat of the DEA emerged in 2000.

It’s the state of the medical profession that has me so pessimistic about the future of pain treatment, and the futures of all the involved patients and doctors. If we had an army of doctors out there who knew opioids, knew how to use them, and were inclined to do so, but were deterred only by the threat of the DEA, then all it would take would be the backlash created by Siobhan’s efforts, the recent media coverage, and a lobby of outraged patients to tip the balance, put the DEA to flight, and change things.

But there is no such army of doctors. Instead there is a large mass of doctors who don’t want to hear about it, doctors who aren’t about to admit how callous and ignorant they have been, and doctors who perceive the ready availability of opioids as a threat to their very lucrative practice of “alternatives.”

It is this huge majority of doctors, with attitudes ranging from apathy to outright hostility, who staff the Deering Clinics of the country. And it is one of this huge majority that will be approached by the media, or the staff of a Senator Bachus, or anyone else who is concerned but who is trying to check out the real facts. And so their interest dies a quick death.

I am the last person on earth to be an apologist for the DEA, but I will concede that there are probably some agents who actually think they are doing right, and that the majority of doctors are doing right by their patients and treating pain when they should.

When one of the doctors in the community comes up on their radar as prescribing more than the others, they think he must be dirty. It probably never occurs to these agents that the other doctors are the ones doing wrong, or failing to do right. They probably think that the few Tylenol No. 2 tablets they grudgingly prescribe for one or two days is all that a doctor ought to ever need to prescribe.

Again, I say that is SOME agents. The vast majority, I am convinced, don’t care one way or the other, and view pain patients the same way German SS troopers were conditioned to view the “untermensch” of the conquered east European countries in WW II.

But I maintain it is this majority of doctors that stands in the way of any progress in the pain crisis, much more so than a disreputable bunch of bullying agents in a corrupt bureaucracy.

O'Shaughnessy's is the journal of the CCRMG/SCC. Our primary goals are the same as the stated goals of any reputable scientific publication: to bring out findings that are accurate, duplicable, and useful to the community at large. But in order to do this, we have to pursue parallel goals such as removing the impediments to clinical research created by Prohibition, and educating our colleagues, co-workers and patients as we educate ourselves about the medical uses of cannabis.
The Society of Cannabis Clinicians (SCC) was formed in the Autumn of 2004 by the member physicians of CCRMG to aid in the promulgation of voluntary standards for clinicians engaged in the recommendation and approval of cannabis under California law (HSC §11362.5).

As the collaborative effort continues to move closer to issueing guidelines, this site serves as a public venue for airing and discussing these guidelines.

Visit the SCC Site for more information.