A new statement published by the Drug Enforcement Administration (DEA) on physician guidelines for prescribing morphine-based painkillers omits ground rules negotiated over several years by DEA officials and a group of leading pain-management experts, the Washington Post reported Nov. 30.
The statement outlines when a doctor is at risk for being investigated for prescription drug diversion and addresses when doctors can give patients prescriptions to be filled at a later date. The stricter guidelines also address the question of whether patients with known drug problems can ever be prescribed painkillers.
As a result of the new guidelines, many pain doctors and patients are more fearful that they could be arrested for treating pain. The guidelines contradict those agreed upon earlier and posted on the DEA's website in August to address concerns of doctors who properly prescribe narcotic painkillers.
According to Howard Heit, a pain and addiction doctor in Fairfax County, Va., the new guidelines mean that “over 90 percent” of patients and doctors could face investigation.
“This approach is chilling to me, and I work with the DEA all the time,” Heit said. “General practitioners will see this and say, 'Why should I prescribe opioids and risk getting into trouble?'”
In a letter to the DEA, David Joranson, a University of Wisconsin pain expert who led the negotiations with the agency, said the new guidelines dismiss important long-standing practices and leave doctors confused about how to prescribe painkillers.
He added that the new guidelines “are likely to interfere in medical practice and pain management.”
The DEA said it issued the new guidelines because the earlier ones contained misinformation. DEA spokesman Ed Childress said the initial document was “meant to be a general guideline, not an official statement of the agency.”
“The document will be aimed at providing guidance and reassurance to physicians who engage in legitimate pain treatment while deterring the unlawful conduct of a small number of physicians and other DEA registrants who exploit the term 'pain treatment' as a pretext to engage in prescription drug trafficking,” according a DEA statement.
But Russell Portenoy, a top pain specialist at Beth Israel Medical Center in New York, said the new guidelines have changed the “tone of the dialogue in a way that is very worrisome.”
“We're seeing more of an emphasis on law enforcement and less on the legitimate use of prescription narcotics,” he said.