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By Joe Cantlupe
COPLEY NEWS SERVICE

1:08 p.m. October 20, 2004

WASHINGTON – The Drug Enforcement Administration has removed from its Web site a "frequently asked questions" document for physicians and law enforcement in their handling of opioid drugs, saying it contained misstatements.

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Pain control advocates blasted the move, saying the document was meant to support physicians who feared prosecution in prescribing the powerful drugs.

The dispute is the latest chapter in a long running battle between groups that promote more liberal use of pain medication and the DEA, which is considering new restrictions to limit use of some opioid drugs.

Opioids are a family of drugs similar to morphine. They are used primarily to relieve pain. However, because they cause euphoria, may result in dependency and sometimes lead to accidental death, opioids are tightly federally regulated.

DEA officials refused to comment on why the document was pulled from its Web site. But a Wisconsin University pain study group that helped prepare it said the DEA's action took it by surprise.

The federal agency and other organizations spent months working on the document, which was supposed to be a guidepost for physicians and others in health care to ensure a balanced approach in using opioids.

Authorities are concerned about deaths linked to opioid painkillers and abuses of the medication. DEA officials point to a 48 percent increase in emergency room visits linked to one of the medications – the painkiller hydrocodone – between 1998 and 2001.

In an effort to coordinate the prescribing of opioids, the DEA posted information in August on its Office of Diversion Control Web Site under the heading: "Frequently Asked Questions and Answers For Health Care Professionals and Law Enforcement."

At that time, DEA Administrator Karen Tandy said the document was a collaborative effort between law enforcement and the medical community.

Both would "continue to work together to carefully balance the needs of legitimate patients for pain medications against the equally compelling need to protect the public from the risk of addiction and even possible death from these medications," wrote Tandy.

The document removed from the Web site included questions such as "what regulations do physicians need to know and observe when prescribing opioid analgesics for pain?" or "can methadone be used for pain control, and, if so, is a clinician required to have a special license to prescribe it?"

The DEA noted that the agency "focuses its limited manpower and resources on the most flagrant violators" among physicians, noting that a tiny percentage – .075 percent – of physicians registered with the DEA was the subject of agency investigations.

But within two months, the DEA abruptly removed the 32-page document from its Web site. Later, the DEA posted an abbreviated explanation on its Web site.

The DEA said that the previous document had "misstatements and has therefore been removed from the DEA Web site."

"DEA wishes to emphasize that the document was not approved as an official statement of the agency and did not and does not have the force and effect of law," the agency added. "DEA recognizes that the proper use of controlled substances in the treatment of pain remains an extremely important issue. Accordingly, DEA intends to address this matter in the future."

Officials of the University of Wisconsin Pain and Policy Studies Group, which worked for two years on the opioid document, said they were surprised by the DEA announcement, a pain and policy studies group spokeswoman said.

"Our group was co-author (with the DEA), and the withdrawal of it was a bit of a surprise," said Jody Garthwaite, the spokeswoman for the pain study group at the university, referring to the Web site document.

"We were notified by the DEA they were removing it from the Web site," Garthwaite said. "They did not indicate to us the reasons why. We did not remove it immediately and received a follow-up written request (from the DEA)."

Although DEA officials reported misstatements on the Web site, "they have not identified them," Garthwaite said.

Officials at the university were disappointed because "this was completely pro bono, two years of work in developing, and peer review by different organizations," she said. "The purpose was to alleviate concerns of doctors for prescribing opioids, just give them that reassurance that the DEA was on board for a balanced approach to treatment."

Representatives of the Association of American Physicians and Surgeons Inc. said they believed the document was a step in the right direction to help physicians in dealing with opioids.

But the DEA has now set a wrong message – by not saying anything, said Kathryn Serkes, spokeswoman for the association, which is a non-partisan professional organization representing physicians.

"They have been unresponsive, completely unresponsive," she said.

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