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In late June, the House Subcommittee on the Constitution held a hearing on "The Pain Relief Promotion Act of 1999" (HR 2260, S.1272). The new bill is meant to be an improvement over last year’s controversial—and ultimately, unsuccessful—bill, "The Lethal Drug Abuse Prevention Act of 1998." (See Exchange, August and September 1998) Unlike last year’s version, the "Pain Relief Promotion Act" would establish programs to foster research and education in palliative care, along with programs to train law enforcement officials on medically accepted means for treating pain.
Because the bill would amend the Controlled Substances Act (CSA), some of its proposals have the potential to add to public and professional confusion about pain control, while muddying issues of drug enforcement. The bill seeks to codify "double effect," in which clinicians are not penalized when medication used to control pain simultaneously hastens or increases the risk of death. The bill would also add to the CSA a stipulation that it is illegal to distribute a controlled substance for the purpose of causing death or for assisting another person in causing death.
Opponents believe by increasing DEA scrutiny of physicians, the bill is likely to make clinicians even more reluctant to prescribe appropriate (or adequate) pain medications. Several witnesses noted that any bill that explicitly authorizes the DEA to determine a physician’s or pharmacist’s intent in prescribing opioids will diminish their willingness to adequately prescribe pain relief. As one witness, David Orentlicher, M.D., J.D., testified, "When intent is the critical issue, physicians must—and will—worry that law enforcement officers will see a criminal intent even when none existed." At the least, the image of trying to convince a skeptical law enforcement officer of one’s intent is frightening to physicians and pharmacists.
David E. Joranson, Director of the Pain & Policy Studies Group at the University of Wisconsin Comprehensive Cancer Center told the committee, "[P]ain is not adequately managed in this country . . . due, in part, to the under-use of opioid analgesics, especially, but not only, for people at the end of life." Joranson added that "while many physicians still do not have sufficient knowledge about pain management, they also fear being investigated if they prescribe ‘too much.’"
Some organizations note that the bill’s narrow definition of palliative care would present further problems for DEA agents charged with determining what constitutes a "legitimate medical purpose" in the context of palliative care. Such medical determinations are traditionally left to the States.
Others opposed to the bill include the American Pain Foundation, the American Pharmaceutical Association, and the American Society of Health-System Pharmacists. The National Hospice Organ-ization and the American Medical Association opposed last year’s bill, but support the new version. Advocates and others concerned with better health care can voice their concerns by writing or calling their representatives in Washington, and urging Congress to hold hearings on the three bills.
Page four features comments by ABCD president Joanne Lynn, M.D., outlining ABCD’s concerns about the Pain Relief Promotion Act of 1999, the full text can be found on the web at www.abcd-caring.org
Jeffrey Ross, a summer associate for ABCD, is a law student at St. Louis University.
