Prescription Painkillers Cause Problems for Patients, Doctors and Prosecutors

But Andringa said Paey illegally manipulated the medical system, forging prescriptions and tricking different doctors into giving him more medicine than he was supposed to get.

"If Mr. Paey is the poster boy for the pain patients of the world, then I suppose Enron is the symbol for corporate responsibility," he said, "And I realize that sounds kind of harsh, but I really believe in my heart that people like Mr. Paey have made the treatment of pain more difficult for patients, for doctors."

Ironically enough, Paey is now getting the treatment for his chronic pain that he had such trouble finding outside of the prison walls. A morphine pump the size of a hockey puck has been sewn into his side, delivering a controlled dose of medication.

Paey is appealing his conviction. But should it stand, he could very well find himself locked up until he is an old man.

A Law Enforcement Scourge

Suspicion is not unique to Paey's story. Across the country, there is a thriving black market in prescription painkillers -- in some places known as "hillbilly heroin" -- that has become a major cause of crime and a focus of law enforcement.

In Kingsport, Tenn., an industrial town nestled in the Appalachian foothills, a sting operation led to the arrest of Dr. William Hurwitz, a Virginia internist who specialized in treating pain. Prosecutors claim hundreds of his prescriptions wound up in the hands of drug dealers who sold painkillers across the mid-Atlantic region. He claims he was scammed by his patients, but a jury convicted Hurwitz of drug trafficking in December. He was sentenced to 25 years in prison but is appealing his conviction.

Supporters of Hurwitz believe he is the scapegoat in a larger federal crackdown on physicians who treat pain. But Karen Tandy, who heads the DEA, said it only targets the most egregious abusers of the law.

"The number of doctors that have been arrested by DEA or the number of cases that DEA's participated in is less than one-hundredth of 1 percent of all the registered doctors," Tandy said. "It was 42 this year. It was 50, a little over 50, last year. So it's a very small number of doctors."

But Dr. Russell Portenoy, a pain specialist at New York's Beth Israel Hospital, said he and his colleagues increasingly are concerned about the criminal prosecution of doctors who prescribe pain medication.

"Physicians, in the last year, have begun to view the DEA as an adversary or have begun to feel increasingly suspicious that the DEA is so focused on prescription drug abuse that they're willing to sacrifice appropriate medical care, at least in certain circumstances, in order to reduce prescription drug abuse," Portenoy said.

Is Fear Hurting Patients?

For Cynthia Hildt, 70, chronic pain began after seven surgeries on her spine. For years, she said, it went largely untreated because doctors were so wary of prescribing all of the painkillers she needed.

"It was all concern about addiction, addiction, addiction," Hildt said. "I got so tired of hearing that word. I constantly said to these people, 'If you felt what I feel in my body right now, you would do anything to fix it.' "

But now, Portenoy is treating her and she is taking daily doses of morphine and methadone that are 20 to 40 times higher than a typical trauma or surgical patient would receive.

"In the chronic pain setting, what often happens is that doses may rise over time, and patients end up taking quite large doses," Portenoy said.

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