March 26th, 2018

Patients With Chronic Pain: Collateral DEA Damage

A sad scenario of unintended consequences is playing out across the country as actions are being taken to remedy decades-old overprescribing of opioid pain medications. After the Centers for Disease Control released guidelines in 2017 for safer prescribing of opioid medications, physicians began to reduce prescriptions of these medications. Sometimes, however, this is happening so quickly that patients are unable to find new prescribers for the medication that they legitimately needed.

A large-scale example of this problem is unfolding right now in Baltimore, where on February 27, the DEA “raided” a large Towson, Maryland medical group practice specializing in pain management. While no charges have been filed and the practice will continue to operate, the multiple prescribers in the practice have voluntarily surrendered their licenses to prescribe controlled substances.

This means that hundreds of their patients, many of them with very complicated medical problems, will need to find another prescriber on short notice. This is occurring when pressures are being applied to all physicians to reduce their prescribing of opioids for their own patients, much less new ones. I am one of the physicians who has received inquiries and am planning to see if any of the patients who are struggling with both opioid addiction and pain can be accommodated in the Kolmac recovery program, either at an outpatient rehabilitation on continuing care level of treatment.

The local physicians with whom I have discussed this issue all share the fear that some of these patients will be driven, in their desperation to reduce their withdrawal symptoms, to seek street heroin, which is being adulterated with fentanyl, and become an overdose victim.

Is there a longer-term answer to this problem that would allow both issues to be addressed? Theoretically, an easy one would be for the DEA to factor immediate patient welfare concerns into their interventions, rather than just attend to longer-term issues. This could involve providing a reasonable transition time or assign a coordinator to help these patients find new prescribers. If and when this process could be implemented is highly questionable, however, and in any event will not be of help to the current group of patients who are scrambling for care.

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