Practicing good medicine for chronic pain patients is not a crime!

William E. Hurwitz, the prominent doctor on trial here for drug trafficking, spent more than two days on the witness stand last week telling a jury why he had prescribed painkillers to patients who turned out to be drug dealers and addicts. But the clearest explanation of his actions — and of the problem facing patients who are in pain — came earlier in the trial.

The problem -- too many doctors don't want to give opioids to treat chronic pain, wven though they are often the most effective medications. The result is that patients suffer -- and are often incapacitate -- by pain that can be relieved. Indeed, chronic pain patients are often dismissed and given les effective treatments by doctors adhering to old ways of doing things or covering their butts out of fear of prosecution by over-zealous prosecutors.

Consider this testimony from defense experts (who testified for free, unlike the prosecution experts) about the standard of care given by Dr. Hurwitz.

Prescribing opioids was once taboo because of concerns over patientsÂ’ becoming addicted. But medical opinion gradually shifted over the past two decades as researchers concluded that high doses of opioids could sometimes be safer and more effective than alternatives like surgery or injections.

Two of the leading pain experts, Dr. Russell K. Portenoy of Beth-Israel Medical Center and Dr. James N. Campbell of Johns Hopkins University, testified without pay as experts for the defense. They said Dr. Hurwitz was widely known as a knowledgeable physician and passionate advocate of giving patients full pain relief, unlike many doctors who were reluctant to prescribe opioids because they feared legal repercussions, particularly when dealing with patients who sometimes used illegal drugs.

Such “problem patients” consumed so much time and energy that most doctors refused to treat them “regardless of what the consequences would be for the patient,” Dr. Campbell testified. He said that he had been initially skeptical of some of Dr. Hurwitz’s high-dose treatments, but was then impressed by the results in patients he sent to Dr. Hurwitz.

He said some doctors might argue that Dr. Hurwitz was guilty in some instances of negligence that would make him liable for damages in a civil case. But Dr. Campbell contradicted the prosecution’s experts by testifying that all the prescriptions were clearly within the “bounds of medical practice.”

But sadly, fear of prosecution is a real problem. One physician's office I was in recently had signs posted stating that "This office no longer prescribes Oxy-Contin, Lortab, or Darvocet" -- medications that are among the best out there for dealing with constant, debilitating pain. Good medicine? No -- good legal advice, after a visit from an inspector from medical regulators concerned about the number of his patients on pain medication. Another doctor I know insists upon a monthly visit from her patients seeking refills of pain medication they have been on for chronic conditions, after being asked by an insurance company to justify the number of pain pills she prescribes each month o its patients. And my wife's neurologist has had to document her case (as well as all his other patients) in excruciating detail to justify her level of pain medication -- to satisfy the demands of his lawyer, not best medical practices, so that he stays out of jail.

This prosecution is particularly troubling because Dr. Hurwitz was generally viewed as one of the leaders in his field. If they can go after him over disagreements on how to best manage the symptoms of chronic pain patients, how intimidated should every other doctor in the field feel? And if the level of risk becomes too high, what will be the fate of my wife, and hundreds of thousands of patients like her around the country?

Posted by: Greg at 10:57 AM | Comments (1) | Add Comment
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