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The pain wars escalated last April when Virginia internist Dr. William Hurwitz was sentenced to 25 years in federal prison after 16 former patients testified against him and a jury found that the death of another patient was caused by an overdose. Hurwitz's assets were seized, and now he is appealing his conviction with the help of the pain foundation and the Association of American Physicians and Surgeons. Hurwitz defenders acknowledge that he may have practiced overly aggressive medicine and allowed addicts to snooker him, but insist he never profited from drug sales and was not a criminal. "Maybe his license should have been suspended," says Dr. Russell Portenoy, chairman of the Department of Pain Medicine and Palliative Care at Manhattan's Beth Israel Medical Center. "But there was no evidence that his patients were not in pain."
That's not how DEA administrator Karen Tandy sees it. "Dr. Hurwitz was no different from a cocaine or heroin dealer peddling poison on the street corner," she told reporters after his sentencing. Prosecutors said Hurwitz prescribed "obscene" amounts of medicine to patients he knew were addicted to cocaine and other drugs. As for the DEA's other investigations and prosecutions, "We're not on a witch hunt," Tandy told TIME. "We are very careful in our investigations. More than 600,000 doctors are registered to prescribe controlled substances. There are a very small number of bad apples." Her agency, she says, has stepped up its investigations because of an "explosion" of illegal-prescription-drug abuse. "People are dying out there."
The use of opioids--medicine originally derived from poppies--dates back thousands of years. They were widely available in the U.S. until the public, alarmed by the growing number of addicts, called for strict anti-narcotics laws in the early 20th century. In the public mind, opioids such as morphine and laudanum, although they remained the most effective pain relievers, became associated with their illegal cousins--heroin and opium--and doctors often shied away from prescribing them.
But opioids made a comeback in the 1980s, after patient groups and physicians focused attention on the problem of under-treated pain. Research showed that addiction did not necessarily result from aggressive, well-managed opioid therapy. In the 1990s, as the specialty of pain management grew in hospitals and universities, opioid use spread from cancer and end-of-life patients to the chronic-pain victims of industrial accidents, car crashes and conditions such as migraines, diabetes and rheumatoid arthritis.
But as local internists began to prescribe stronger pain-killers for regular patients, some of those drugs--no one has reliable figures--began to flow into the black market, whether through pharmacy and warehouse theft, Internet sales or the scamming of legitimate doctors. When OxyContin, a time-release version of the opioid oxycodone, was introduced in 1995, drug addicts learned to grind up the pills to get a quick, intense high; in pockets of Appalachia, Maine and Ohio, OxyContin became the drug of choice. Meanwhile, celebrity abusers--including Rush Limbaugh and Courtney Love--sparked a flurry of publicity, leading politicians to push for a crackdown on what was being called an epidemic of prescription-drug abuse.