Speech

Administrator Tandy often departs from prepared remarks

Karen P. Tandy
Media Roundtable
Policy Statement
Dispensing Controlled Substances for the Treatment of Pain
Arlington, Virginia
September 6, 2006 10:00 AM

Today, DEA has good news for people in chronic pain who need medication to control their pain and bad news for those who divert these drugs.

At noon today, DEA will be announcing 3 new steps that we are taking to ensure that people who medically need drugs get them, and that those who are diverting them, don’t :

  • First, we’re proposing new regulations that will make it easier for doctors to prescribe Schedule II drugs for chronic conditions.
  • Second, we’re issuing a first of its kind policy statement to give the medical community the information they requested on prescribing and dispensing controlled substances to treat pain.
  • Third, we are launching a new page on our website to provide everyone with the facts on DEA cases against doctors who violate federal drug laws.

These are all firsts.

Before I get into each of these, let me tell you how we got here.

We all know that prescription drugs help millions of Americans every day, including those who suffer from chronic pain. When it works right, they get desperately needed relief. Taken outside of medical necessity, these drugs can and do kill.

  • Today, more than 6 million Americans are abusing PRESCRIPTION DRUGS---that is more than the number of Americans abusing cocaine, heroin, hallucinogens, and inhalants, combined.

    Think about that number—6 million is a huge number of people – it would be the equivalent of the combined population of Chicago, Houston, and Philadelphia.

  • If we look at the people who are just starting out as new drug users, prescription drugs have overtaken marijuana and cocaine as the drug of choice.

  • Most parents don’t realize that nearly 1 in 10 high school seniors admits to abusing powerful prescription painkillers, specifically Vicodin.

  • And finally, opioid painkillers now cause more drug overdose deaths than cocaine and heroin, combined.

Some teens and adults ask what harm can a prescription high do? The families of Jason Surks in New Jersey and Ryan Haight of California know the harm. Their 19 and 18 year old sons overdosed and died from prescription narcotics that they bought over the Internet. Neither of these boys—not Jason or Ryan—imagined that prescription drugs would kill them – People need to know how deadly this kind of abuse is.

It’s DEA’s job to enforce the federal drug laws that were enacted to protect the public from this very danger.

Doctors practice medicine. DEA simply enforces the law to ensure that controlled substances don’t end up in the hands of abusers and traffickers.

And these abusers get prescription drugs from a whole host of sources:

from the Internet,
burgulary, theft, and stealing from pharmacies,
doctor shopping to collect pain pills, and
some are just forging their prescriptions.

Unfortunately, a small number of unscrupulous doctors are also illegally supplying those drugs. Although there are very few of them, they are doing tremendous damage. One such doctor in Panama City, Florida, was diverting so many OxyContin pills to abusers and traffickers that after DEA arrested him, the street price of OxyContin nearly doubled in the area because of the significantly diminished availability of OxyContin.

THESE are the doctors DEA investigates -- ones who knowingly and egregiously put drugs into the hands of traffickers and abusers.

This isn’t just questionable behavior. There is no gray area here. It’s a clear cut violation of criminal law.

DEA’s responsibility to enforce the law, however, does not diminish our firm commitment to the balanced policy of promoting pain relief and preventing the abuse of pain medications.

To make sure we get it right, we have spent considerable time -

  • Meeting with representatives from the medical community, treatment providers, pharmacists, state pharmacy and medical boards and prosecutors, and
  • Listening to the comments of more than 600 medical professionals, patients, and others affected by chronic pain and other chronic conditions.

We are convinced—I am personally convinced—that after this careful and thorough process – DEA has stayed in our lane under the law, that we have stayed out of the practice of medicine, and that the new steps we are taking today are the most effective way to strike that critical balance between promoting pain relief and preventing the diversion and abuse of powerful prescription drugs.

[Federal Register]:

First, we are proposing a new rule that if it becomes final – will permit doctors to issue multiple Schedule II prescriptions during a single office visit, allowing patients to receive up to a 90-day supply of controlled substances according to the fill date that the doctor gives the pharmacist.

The law prohibits refilling powerful Schedule II controlled substance prescriptions but the regulations that implement the statute did not address the issuance of multiple prescriptions. There was silence in the regulations on this.

We heard from hundreds of doctors and patients about the burdensome requirement of repeated visits to a doctor’s office each month to get a new prescription for an already diagnosed chronic condition such as Attention Deficit and Hyperactivity Disorder or chronic pain.

We hope to fix that…which is why we are proposing a new regulation.

Second, we are publishing in the Federal Register today, a first of its kind policy statement that answers doctors’ questions about dispensing pain meds and the laws DEA must follow.

[Website]:

Next, some doctors say that they fear DEA enforcement, so much so that they no longer prescribe pain medication. But the fact is, that less than 1/10th of 1% of the more than 770,000 DEA physician registrations in our country are revoked in any given year. Only 12 % of the doctors investigated by DEA in 2005 were pain specialists.

Last year was the largest number of doctors we arrested at 62, but it was still less than 1/10th of 1%. So far this year, we’ve arrested 31.

So, to give doctors the comfort level to prescribe all medically appropriate pain relief to their patients without fear of enforcement action, today we are launching an innovative new page on our website, www.dea.gov, called "Cases Against Doctors," which lists the public facts from our cases against doctors.

With this new Webpage, everyone, including doctors, will see the limited number of doctors we take action against and what causes us to initiate these cases. Most were referrals from state medical boards or their peers.

Law-abiding physicians will see that doctors on this webpage engaged in criminal activity that 99% of doctors wouldn’t even dream of committing.

What you’ll see is that:

  • We stopped doctors who sell medically unnecessary prescriptions for cash.
  • Doctors who exchange narcotics for sexual favors.
  • Doctors who write prescriptions to make-believe patients so that the drugs could be sold on the street.
  • Doctors who prescribed vast quantities of drugs to patients who admitted outright that they were re-selling the medicine. It is astonishing, but these patients have even tested positive for illegal drugs, have had needle tracks up and down their arms, and yet they were still getting these powerful painkillers.
  • And, finally, we stopped doctors who have written prescriptions to patients and then require the patients to give the doctor some or all of the pills for the doctor’s use, to feed the doctor’s own addiction.

To start with, this new webpage reports ALL of DEA’s administrative cases against doctors since 2003 and 25 of the criminal cases that were concluded by trial or guilty pleas. These were the first easy ones to begin posting.

Over the next 90 days, we expect to gather the balance of the criminal case records and publish the facts of the remaining cases against doctors on the Webpage, and then continuously thereafter update the Website with any new cases. This website is the first time this has ever been done; it is the first time a law enforcement agency has posted what caused them to initiate the case.

[Updated Practioner’s Manual]:

Finally, to help doctors understand their shared responsibility to prevent diversion and abuse, DEA also has updated our Practitioner’s Manual and posted it on our Website today. Beforehand, DEA asked a number of doctors to review this manual, which updates the earlier 1990 edition, and the doctors found the new edition to be very helpful in understanding their legal obligations in prescribing drugs and the process.

The bottom line is this --

Doctors need to practice medicine as they have been trained to do and what they are sworn to do: to help their patients by delivering all medically necessary pain relief, and

DEA will do what we are sworn to do: enforce our nation’s laws to ensure drugs are used only for the health and welfare of the public---and to ensure that these drugs don't feed addictions, or ruin innocent lives. Thank you.

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