Journal of the California Cannabis Research Medical
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
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
before the DEA shifted their targets to doctors. I will bet that
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.