On a cold morning last April, in the shadow of Montana's Beartooth Mountain range, five agents from the federal Drug Enforcement Administration (DEA) walked into the office of Dr. Richard Nelson, a Billings neurologist. For six hours, they combed through his records, seizing 72 patient charts and confiscating his drug-dispensing permit. The charge? None so far, but the assumption is that he is suspected of improperly prescribing narcotic drugs. Despite a distinguished professional record spanning more than four decades, Nelson has had to spend $20,000 on lawyers, fearing that the government will indict him if it turns out that one of his patients has misused his medicine. "My practice is sunk," says the 73-year-old physician, who specializes in chronic-pain treatment. "I can't even write a prescription for Tylenol 3 if someone has a migraine."
The DEA, for its part, says it was acting on tips from "several individuals in the community and pharmacies ... regarding suspicious prescriptions," according to a spokesman, who declined to elaborate.
It's a messy situation. No one is denying that federal and state officials, under pressure to combat a spike in pain-killer abuse, are waging an escalating war on drugs that is spilling into the waiting rooms of neighborhood doctors. Over the past six years, more than 5,600 physicians from Alaska to West Virginia have been investigated on suspicion of "drug diversion." Some doctors allegedly prescribed narcotics too freely, while others issued them to patients who turned out to be dealers or addicts. More than 450 doctors have been prosecuted on charges ranging from illegal prescribing and drug trafficking to manslaughter and murder.
But in the government's new crackdown, legitimate physicians and patients may be getting caught in the net. "Fifty million Americans are in severe pain from arthritis, back injuries, cancer and other disabilities," says Dr. Scott Fishman, president of the American Academy of Pain Medicine. "But the government is sending a message to avoid prescribing strong pain-killers."
Ultimately, it may be the patients who get hurt most, because a growing number of doctors, frightened of government scrutiny, are avoiding the use of powerful narcotics such as OxyContin, Vicodin, Percocet and Dilaudid. "It is impossible to be sure that a patient is not diverting any of his medication," says Dr. Thomas Stinson, a Medford, Mass., anesthesiologist who is closing his 20-year practice to new pain patients. "I fear I might be targeted."
In the past year, hundreds of sufferers have contacted the Baltimore-based American Pain Foundation. "They've gone to every physician within hundreds of miles and can't get someone to prescribe to them," says executive director Will Rowe. In some cases, patients with high-dosage prescriptions are turned away by drug stores, which are also subject to DEA investigations. "It's demeaning," says Mary Vargas, a Maryland attorney whose spine was injured in an auto accident. "Pharmacists tell me they don't have the medication, only to recant and dispense it when I persist with the manager."