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.
###
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.
MD
JUNCTION: Find a Doctor, Know Your Doctor-
This is one comprehensive website where you can
find the doctor you need. I like this site a lot, so please do
give it a visit.
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.
Cletus Nelson is an LA-based freelance writer who specializes
in conspiracy, hidden history and drug war politics. His writings
have been published by disinfo, Lew Rockwell, Counterpunch, Signum,
and several other publications. Nelson's skeptical analysis of the
Oklahoma City bombing evidence appears in the disinfo anthology
You Are Being Lied To (2001, The Disinformation Company Limited).
