Where I Stand — Mike O’Callaghan: Drugs: Both good and bad

Friday, Jan. 17, 2003 | 5:54 a.m.

ALMOST THREE weeks ago the Las Vegas Sun newspaper published a story about Nevada's Prescription Drug Monitoring Program. The program requires the state's pharmacists to submit the names of people who have purchased painkillers and other potentially addictive drugs prescribed by doctors.

Reporters Cy Ryan and Judy Odierna wrote: "Nevada authorities say their system is different from those of other states where the information is routinely funneled to police agencies.

" 'This is not used as a law enforcement tool,' said Louis Ling, attorney for Nevada's Prescription Controlled Substance Abuse Prevention Task Force.

"That 15-member task force tracks everything from hard-core narcotics to prescribed painkillers and anti-anxiety medication like the frequently prescribed Xanax and Valium pills. It is composed of representatives from boards that license doctors, veterinarians, dentists and pharmacists as well as physicians who specialize in the treatment of addiction. One member is from the Nevada Division of Investigations ...

"In Nevada, use by law enforcement of the prescription drug information is limited, he said. The task force turns over the data to police only after it is verified that they have an open investigation of the individual. That must be verified, Ling said."

Alan Lichtenstein, general counsel for the American Civil Liberties Union of Nevada, doesn't see the state program protecting the confidentiality that should exist between doctors and patients. Even a possible bigger problem could be the fear of doctors resulting in not providing enough pain relief. He said, "A lot of people with terminal cancer or patients that are dying in agony are not getting the proper pain medication because doctors are frightened about being investigated for being a drug pusher."

Lichtenstein's concerns reminded me of some prior columns written in 1998 and 2000. Sen. Don Nickles, R-Okla., introduced a most promising Pain Relief Promotion Act that also provided an additional $5 million for research and education for pain management. The last time we heard about the bill is when it died in committee hearings three years ago.

Nickles, in a prepared statement, told the hearing, "Pain is a major public health problem in the United States, afflicting tens of millions of Americans of all ages and walks of life.

"Pain, whether acute, chronic, or at the end of life, is the most common reason individuals seek out medical care. Despite the prevalence of pain, it is largely a disease without a constituency. Unlike arthritis, diabetes, cancer and the many other conditions with which pain is frequently associated, treatment of pain has been largely neglected in medical education and in the public debate."

Nickles went on to mention the problem that still exists in controlling pain when saying, "Patients who need the medication and treatments necessary to eliminate pain and discomfort face other hurdles. There are fears and misunderstandings, whether real or perceived, regarding regulatory authorities, both state and federal, particularly the prescribing of controlled substances. And from the patient's side there is a fear of dying, especially dying in pain and becoming a burden upon others."

The Federation of State Medical Boards of the United States Inc. has provided model guidelines for the "Use of Controlled Substances for the Treatment of Pain," which the Nevada Board of Medical Examiners adopted. It's a good model and provides an adequate structure for use. I'm not convinced, however, that it also provides the reassurances that all doctors may need when treating pain.

Five years ago an editorial in the Journal of the American Medical Association stressed that "undertreatment of pain is a persistent clinical problem ..." Now we must ask: Just how much has this situation changed since that editorial?