The Painful Truth: How Pain Management Professionals are Being Undermined by Vague Laws

By Jack Stein, Class of 2015

Everyone has a different tolerance for pain.  Some people can have a dangerous injury and either not notice it or think that they can handle it on their own.  Others find themselves in great pain with every knock or bruise and think that they need drugs such as OxyContin to cure it.  As a result, it is almost impossible to judge objectively the level of pain that a given individual is in.  The common way doctors attempt to judge a patient’s pain is a 0 – 10 scale (0 being no pain at all, 10 being absolutely unbearable).  However, each person’s scale is subjective to their experience of pain in the past, making it almost impossible to have a consistent ranking of pain for the same injury suffered by two different people.  Because of this ineffective means of identifying pain, many exploit the system and trick their doctors into prescribing more drugs than are needed for the pain.

This subject is explored in Tina Rosenburg’s New York Times article “When is a Pain Doctor a Drug Pusher?” which discusses the dilemma doctors face when treating a patient as to how real their pain is and what dosage to give the patient.  She argues that there is a problem in the way the law allows doctors to prescribe opioids.  One doctor may prescribe an unhealthy, even fatal amount of opioids to a patient without breaking a law.  Another might be scared to prescribe a reasonable amount for fear of the patient misusing them, which could result in the doctor being arrested. Federal law for the distribution of pain medication uses imprecise legal definitions of terms, and Rosenberg argues that this allows for confusion between real patients and addicts.  It is this very law which thousands of addicts try (and often succeed) to break for personal benefit.  Basically, the law puts the distribution of opioids in the hands of the doctors, some of whom are far less educated about pain than one would hope and expect.

Rosenberg cites the case of Ronald McIver, a pain management doctor with an aggressive style of treatment.  He often prescribed double the amount of opioids usually recommended, sometimes even sixteen times the recommended amount. Because pain can only be measured subjectively, McIver always overcompensated in his treatments, aiming for the pain to be a 2 instead of 5 on the 0 – 10 scale.  However, McIver’s style led him into some serious problems.  Some of his patients would fake pain to use the drugs for their ad

dictions.  Others would sell the excess drugs on the black market.  Some patients would drive hundreds of miles just to see McIver, who attempted only weakly to investigate the reality of their pain.  Even before all the  forms were filled out from the patients’ previous doctors, McIver would still prescribe an unusually high amount of drugs.  In cases of doubt, McIver always erred on the side of giving too many pills rather than not enough.

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Rosenberg’s main argument is that the laws about pain management and medication are too vague.  In fact, many jurors and investigators could not find an exact law that McIver broke, despite a clearly harmful and dangerous method for giving prescriptions for opioids.  Many doctors are being prosecuted for stepping over a line that has not even been established, and with pain education being taught in so few medical schools, it is likely to continue like this for some time.  Rosenberg maintains that misconceptions dominate public opinion.  Many doctors live in fear of prosecution for prescribing controlled substances for pain. This needs to be resolved sooner rather than later, says Rosenberg, because real patients are living in pain.  Despite the potential for abuse, opioids such as OxyContin help thousands of pain victims get back to their normal lives.  As it stands, the laws about opioid distribution fail to account for the benefit of such drugs, and as a result many legitimate pain patients have no where to go and no hope for successful recovery.

Rosenburg states that a huge part of the problem as it relates to pain management is the general ignorance of the problem and a proper solution.  Because of this, she is able to form the argument from a legal perspective, examining what approaches are and are not allowed.  Ultimately, she makes the right call based on the evidence provided.  According to the facts that she presented, I agree that the government should do a better job of defining its terms of pain medication and increase its awareness across the country. The medications that are being prescribed today are real and dangerous, especially for those who underestimate their power.  In order to understand the dilemma faced by thousands of pain doctors, it is crucial to remember the purpose of medicine in its most basic form: to help the victims of pain and suffering.  Anything other than that should not be legal, and all attempts to avoid the illegal distribution and abuse of the drugs should be punished harshly.

Pain is debilitating, and often the only solution is for doctors to prescribe heavy drugs.  Abuse is rampant and unavoidable, and often the good drugs are misused for bad results.  Doctors are facing persecution for giving their honest opinion, and pain victims are the collateral damage when the doctors get scared away.  After reading Rosenberg’s article, one is left with an uneasy feeling of pessimism as to the way out healthcare system is being run.  The article touches on many of the flaws in the legal system, and it leaves the reader to determine whether or not it should be amended.

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