Why Is The DEA Hounding This Doctor?

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But the dimensions of that epidemic are in dispute--and from unexpected quarters. Last week a spokesman from the White House Office of National Drug Control Policy warned TIME that while prescription-drug abuse is a serious problem, and growing among teens, the numbers in a highly publicized study from Columbia University's National Center on Addiction and Substance Abuse are "not a reliable estimate." The survey describes a near doubling of prescription-drug abuse from 1992 to 2003, but because of changes in the way federal statistics were gathered in the past decade, no such claim can be made, the spokesman said. Last month the libertarian Cato Institute issued a report, Treating Doctors as Drug Dealers: The DEA's War on Prescription Painkillers, charging that the agency exaggerated reports of OxyContin deaths and overdoses. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, which can lead to intestinal bleeding, cause 35 times more deaths a year than OxyContin, the Cato report contended, and are far less effective.

The DEA's $154 million drug-diversion campaign is also under attack by state officials. In a stinging 10-page critique issued last March, 32 state attorneys general, led by Oklahoma's Drew Edmondson, charged that the agency's proposed criteria for investigations would force severely ill patients to make frequent, unnecessary doctor visits, thus increasing both their hardship and their co-payments. "DEA is creating a climate that ... discourages good practice," they wrote. Tandy met with a delegation of attorneys general in April to reassure them that "the last thing DEA wants to do is to chill the legitimate prescription of pain medications," promising that new rules would balance medical and legal concerns. Meanwhile, 25 states are taking the initiative, mounting their own electronic systems in pharmacies to catch suspect patients.

As the national debate plays out, Nelson, the Montana neurologist, remains under investigation. He describes himself as a cautious prescriber. A graduate of Washington University School of Medicine in St. Louis, he also trained with the American Academy of Pain Medicine. He required that his patients sign a four-page, 21-item contract before getting any opioid treatment, pledging, for example, that they had never received a diagnosis of substance abuse or been involved in drug dealing, that they would not seek to replace lost medication or obtain early refills and that they would buy their drugs from only one designated pharmacy. Monthly checkups and extensive tests--including MRIs and electromyographic studies--were the norm, Nelson says. Over the years, he has dismissed more than 70 patients for not following his rules.

Since the DEA raid, many of Nelson's patients have been unable to find doctors. Few physicians are trained in the complexities of pain control, and fewer still want to risk government second-guessing. Some of Nelson's patients have suffered acute narcotic-withdrawal symptoms, as he was unable to wean them gradually. Others, unable to cope with their pain, lost their jobs. They have staged demonstrations and press conferences in downtown Billings and mounted petition drives. As one of the few Montana doctors offering opioid therapy, Nelson was "like the Mother Teresa of medicine," says Jeannie Huntley, a marketing consultant who suffered brain and neck injuries from a car crash.

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