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THE WAR ON PAIN RELIEF

The DEA’s ongoing efforts to ruin the practices of the remaining doctors who will treat chronic pain patients scores yet another victim

by Cletus Nelson- Special to DrugWar.com

April 2, 2002

The onset of Spring is an eventful time for the Drug Enforcement Administration (DEA). With Senate Appropriations hearings on the immediate horizon, it is a frenzied season of high-profile tactical encounters cynically orchestrated to convince Congress that the agency is gaining ground in its battle for a zero tolerance world. Typically, this solemn bureaucratic ritual involves some newly discovered “killer” drug and a media-hyped campaign warning of its alleged dangers. This year’s “assassin of youth” is an innovative painkiller known as OxyContin and the ensuing crusade to end its abuse has placed a North Carolina pain specialist and his many patients in the Drug War’s deadly crossfire.

Conflicting Visions

Depending on whom you talk to, Dr. Joseph Talley is either of two people. On the one hand, he’s perceived as a compassionate country doctor with a sterling reputation; on the other, he’s a shady backwoods narco-peddler who transformed his small Cleveland County practice into a haven for addicts seeking a legal high.

The DEA have adopted the latter position, forcefully arguing that Talley’s zeal for prescribing morphine, OxyContin and other powerful painkillers contributed to the overdose deaths of nearly two dozen people. Yet his staunch supporters consider him a rare man of integrity whose only sin is perhaps caring too much about the thousands of desperate souls who gravitated to his “clinic of last resort” in search of relief.

While it is left to the discerning reader to decide which is the more accurate picture, few will deny that Talley’s ordeal illuminates how self-serving prohibitionists have perverted the healing profession. Indeed, by coercing doctors into withholding effective pain medications, the gun-toting arbiters of the therapeutic state have consigned millions to a life of unending suffering.

An Unlikely Renegade

The 64-year-old graduate of University of Virginia Medical School certainly doesn’t fit the media stereotype of the pill-pushing doctor. “I would say Dr. Talley is what you think of when you conceive of a small-town country doctor. He’s just an edifice of the community,” asserts Sam Gaines, a supporter and family friend. Nevertheless, since he entered the nascent field of pain management some three years ago, the seasoned physician has become something of a clinical renegade.

While the vast majority of his peers are reluctant to prescribe opiods for fear of drawing the unwelcome attention of overzealous anti-drug cops, Talley openly acknowledges his reliance on highly-regulated narcotics to ease the suffering of his many clients.

“The basic decision you've got to make is if society is better off -- if a patient is better off --if you let a drug addict dupe you and you play into his hands, or let a patient down who really has pain?" Talley remarked to the Shelby Star. “It seems to me to be a no-brainer” he added. He questions why valid pain patients should be left twisting in the wind merely to ensure that a small minority will not abuse these effective drugs. "If the addict fools me and gets his fix, well at least he got a safe drug to abuse," he informed the New York Times. "But if I tell this guy in terrific pain I'm not going to treat his pain and I think you are an addict, that just adds insult to injury. It is just devastating."

The High Cost of Compassion

It is this commendable philosophy which has placed Talley’s career in jeopardy. In late March, the North Carolina State Medical Board ruled that Talley prescribed narcotics such as morphine and OxyContin far beyond currently accepted standards. The regulatory panel also found that the embattled doctor had failed to adequately diagnose and examine patients prior to issuing prescriptions to pain patients. Thus, it is now uncertain whether Talley will be allowed to continue practicing medicine.

In a spirited (but unsuccessful) defense, Talley's Attorney Robert Clay called expert witness Dr. C Stratton Hill of the University of Texas in Houston who countered that the doctor’s treatment methods were above reproach and “well within the standard of care.” Clay also pointed out that there is no administrative or legal measure which specifically dictates that healthcare providers conduct extensive examinations prior to recommending a narcotic regimen for a particular patient. Talley also testified that the majority of his pain patients were poor or lacked medical insurance and could barely afford his $55 dollar fee much less a battery of costly tests and examinations.

“A lot of other physicians want nothing to do with these patients,” Dr. Ron Delaney informed the Shelby Star in a February interview. Delaney, who worked alongside Talley at his clinic for four years, denies ever witnessing any ethical lapses or incidents of unlawful behavior. “They [DEA] came in and found nothing, but they want this clinic closed. It’s part of a DEA campaign across the country.”

OxyContin: Info and Disinfo

This is far from a speculative remark. Over the past six months, DEA officials have shut down Cannabis dispensaries in Los Angeles and San Francisco while prosecutors have been meting out stiff penalties to physicians whose patients overdose on painkillers. Just this month, Florida doctor James Graves received a 63-year sentence after four of his patients overdosed on the controversial pharmaceutical which the media have dubbed “the new heroin” due to the euphoric rush it provides when crushed and snorted by illicit users.

However, as we shall soon see, Talley’s alleged complicity in some 23 overdoses as mentioned in DEA press materials isn’t as clear cut as the agency would like the public to believe. By way of comparison, it is worth examining some Oxy-related overdoses which occurred in Kentucky--the state many consider “ground zero” for the alleged OxyContin “epidemic.” Federal officials (and a compliant press) continue to propagate the notion that 59 individuals perished in a one-year period due to the allegedly lethal presence of the powerful painkiller. However, David W. Jones, Executive Director of the Kentucky State Medical Examiner’s office strongly disagrees; he informed the Cleveland Free Press the number is closer to 27.

Furthermore, Free Press reporter Sandeep Kaushik reports that 23 of the deceased had a “a head-spinning multiplicity of other drugs in their systems, including highly potent prescription painkillers such as Dilaudid and Fentanyl, as well as powerful illegal drugs like cocaine and heroin.” After eliminating those who perished by lethally combining drugs or alcohol, the number of actual OxyContin deaths was closer to 2. Kaushik’s research turned up equally ambiguous deaths in other locales leading him to conclude that “a substantial majority” of those who abuse the effective anti-pain remedy are primarily “long-standing drug addicts” who have switched to Oxy either due to an inability to access harder street drugs or as part of a lifestyle pattern of abusing prescription medications.

Fatal Deception

Roger Huffstetler, a patient of Talley who overdosed last April seems to fit the aforementioned pattern. Although the DEA specifically listed his death in a widely circulated “show cause” order as damning evidence of clinical malfeasance, his wife Fayleen testified at a hearing before the North Carolina Medical Board that her husband was severely addicted to narcotics prior to his untimely demise. Moreover, a withering cross-examination by Talley attorney Robert Clay revealed that Ms. Huffstetler, a former addict herself, had been obtaining prescriptions under false pretenses from Talley’s clinic in order to maintain her husband’s growing habit. “You used Dr. Talley didn’t you?” Clay asked pointedly during a heated exchange. “Probably,” Huffstetler replied.

Forensic Ambiguities

We may not even know if Talley’s prescriptions are responsible for Huffstetler’s death. Oxycodone, the primary ingredient in Oxycontin, appears in over 40 brand name medications. This makes it increasingly difficult for Medical Examiners to determine whether an overdose is the result of ingesting fatal amounts of OxyContin or some other substance with a similar chemical composition.

An October press release issued by Purdue Pharma, the chief manufacturer of OxyContin, reveals that “extreme media reports of ‘hundreds of deaths’ caused by OxyContin were exaggerations and could not be verified by Purdue or the DEA.” Company investigators further state that “because of the presence of multiple drugs” it was nearly impossible to determine if OxyContin or some other substance was responsible for a particular fatality. This includes the “14% of cases where the DEA determined that OxyContin was the source of oxycodone.” Thus, even the most sophisticated forensic analysis is often unable to detect what particular medication was the source of oxycodone.

Until these very salient issues pertaining to the possible presence of narcotics, alcohol or drugs other than Oxycontin are addressed, the DEA accusations against Dr. Talley remain largely unsubstantiated.

By the Book

It is also worth noting that Talley’s reliance on morphine, OxyContin and other drugs to address the critical needs of his patients is in accordance with current views regarding the treatment of what is known in clinical circles as Chronic Non Malignant Pain (CNP). In its “Model Guidelines for treating pain with opioid medication,” the Federation of State Medical Boards recommend that “controlled substances, including opioid analgesics, may be essential in the treatment of acute pain due to trauma or surgery and chronic pain, whether due to cancer or non-cancer origins.” The guidelines, which received DEA approval, also remind physicians that “tolerance and physical dependence are normal consequences of sustained use of opioid analgesics and are not synonymous with addiction.”

The latter statement is backed by substantial research indicating that physical addiction rarely occurs among pain patients treated with narcotics. The National Center for Policy Analysis (NCAP) cites a 20-year-old study which found that two patients out of a sample population of 2,369 individuals who were administered morphine developed any signs of psychological dependence. This is corroborated by the research of Dr. Russell Portenoy who chairs the Department of Pain Medicine and Palliative Care at the Beth Israel Medical Center in New York City. As part of a recent study, Portenoy monitored nearly 25,000 cancer patients taking some type of narcotic regimen and found that less than ten individuals exhibited any signs of addiction.

The Minefield of Pain Control

Unfortunately, Talley’s ongoing trial-by-insinuation illustrates inherent dangers faced by those who work in the nascent field of pain control. Dr. Barry Cole, former President of the American Academy of Pain Management, told CNN that it is “ingrained in the psyche of physicians to not use large amounts of opioids.” Dr. John W. McFadden, a pain specialist and colleague of Dr. Talley concurs with this assessment. “Nationwide there is gross undertreatment of patients with pain. Ignorance and the Drug War are probably the greatest obstacles,” he asserts in a letter of support for Dr. Talley.

There is also the fundamental question of whether a doctor should be held criminally liable if a patient misuses prescription drugs. Additionally, what goals are achieved by punishing legitimate pain patients and their physicians due to the actions of a small minority of miscreants? Pain specialist Dr. C. Stratton Hill tells the Christian Science Monitor that, "It makes no sense that we should establish a public policy based on trying to prevent a few drug addicts from killing themselves.”

Final Exit?

Certainly the estimated 120 deaths alleged to be attributed to OxyContin merit concern, but it is important that these fatalities be placed in perspective. For example, Justice Department statistics show that in 1994 alone, over 2000 Americans perished by ingesting fatal doses of Aspirin. However, there were no demands for public hearings or lurid stories detailing the pernicious influence of Bayer or Tylenol. Should the entire medical profession be held hostage to unfounded fears of patient deaths, the consequences could be far reaching.

Pain experts point out that allowing unqualified law enforcement personnel to second-guess the decisions of experienced healthcare providers has engendered an unprecedented pain crisis with an estimated 40 million Americans suffering from debilitating pain. It is not difficult to foresee what the future holds should the DEA retain its stranglehold over the treatment of pain. One need only examine the many studies indicating that suicidal ideation is quite common among pain patients to understand why the assisted suicide movement is gaining ground in the United States.

The Pain Payoff

Unfortunately, the disturbing specter of state-sanctioned euthanasia will have little effect on the powerful social forces which have much to gain by punishing men like Dr. Talley. Indeed, facilitating the belief that there exists a vast criminal subculture of doctors inflicting the horrors of addiction on unknowing patients will do much to reestablish the DEA’s questionable legitimacy at a time when the public is focused on counter-terrorism efforts. Moreover, our political leadership are no less interested in cravenly capitalizing on these deaths to engage in yet another round of tiresome drug war posturing.

Meanwhile the more unsavory elements of the legal profession are jumping on board in the hopes of filing lucrative lawsuits against the manufacturers of pain medications and the doctors who prescribe them. Despite the presence of contradictory data indicating that the majority of pain patients don’t become addicts and the typical OxyContin abuser has a prior history of prescription or hard drug abuse, various law firms are playing upon the many myths surrounding OxyContin to shake down pain control specialists and Purdue Pharma, the corporation which manufactures the controversial pain medication.

Echoing the “reefer madness” propaganda of the cold war era, one allegedly “informative site” operated by the law firm of Pikoff and Riff absurdly tells possible litigants that ingesting OxyContin has the potential to transform even the most mild-mannered patient into a shotgun-toting, drugstore junkie as “addiction,” “abuse,” and “crime” are listed as possible “side effects” of OxyContin use.

No Winners

Obviously these vested interests have a political and financial stake in convincing vast segments of the public that men like Dr. Talley constitute a public threat. Yet these attempts to cash in on the OxyContin scare will do little to improve the lives of millions of patients and will most certainly deter physicians from aggressively treating chronic pain.

It seems so long as there is a war on drugs, America will remain a nation needlessly in pain.

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SUPPORT DR. TALLEY

Jaye Whitmire, a supporter of Dr. Talley has built this informative web site which includes links to media coverage of his case as well as testimonials and letters of support from Talley’s patients and colleagues.

AMERICAN SOCIETY FOR ACTION ON PAIN

“Stop Drug War ‘Raids’ on Innocent Doctors” exhorts this highly vocal on-line forum dedicated to ensuring that patients receive proper treatment for pain. The web page includes a lengthy article decrying the many doctors who have been bullied, prosecuted, and lost their licenses to DEA thugs. Additionally, the site provides guidance, links, and information for pain patients who may be contemplating suicide. Some of the letters written by suicidal pain patients poignantly underscore the difficulties among those who endure chronic pain.

OXY CON-JOB

Appearing in the May 2-8, 2001 edition of the Cleveland Free Press, Sandeep Kaushik’s explosive expose on the OxyContin propaganda scare and its craven perpetrators provides a searing indictment of the therapeutic state, relentlessly documenting how police, media, and political officials have lied, exaggerated, and profited from unfounded fears of OxyContin deaths. Even more damning, Kaushik illustrates how widespread coverage describing the drug’s ostensibly “euphoric rush” directly facilitated widespread Oxy-abuse.

SUICIDE AND CANCER PAIN

This brief article provides an excellent overview on the nexus between cancer and suicide. Cancer patients are amazingly resilient and able to cope with the life-threatening illness. Yet when the threat of intolerable pain enters the picture, poor pain management will greatly increase the chances of depression, and possibly requests for doctor-assisted-suicide.

DO I HAVE TO DIE IN PAIN?

This investigative report posted to the PBS web site outlines the growing fear of uncontrollable pain among terminal patients. The featured story emphasizes the social and cultural barriers that often inhibit the prescription of narcotics and our “unfounded” fear of addiction.

AMERICAN PAIN SOCIETY

The American Pain Society (APS) is a positive outgrowth of America’s ongoing battle over pain. This influential consortium of doctors and health care professionals promote a greater awareness of pain management techniques among medical professionals while urging (and facilitating) innovation in this long-ignored field of medicine. Their web page includes links, publications, and up-to-the minute news.

DEA PUTS PATIENTS IN PAIN

A brief, yet informative fact sheet provided by the National Center for Policy Analysis which outlines the arguments in favor of Morphine use as a palliative for pain.

IN SEARCH OF A NEW ETHIC FOR TREATING PATIENTS WITH CHRONIC PAIN: WHAT CAN MEDICAL BOARDS DO?

Ann Martino discusses the tendency among doctors to underprescribe narcotics, and the institutional failings and fear of prosecution which fuel this dangerous practice.

THE QUALITY OF MERCY

Societal views toward pain, narcotics, and assisted suicide are explored in this informative US News and World Report cover story by Shannon Brownlee and Joannie M. Schrof which appeared in May 1997. The authors warn that the assisted suicide movement is gaining followers the more medical officials and our political leadership ignore this crucial issue.