Big Hearing at the Tenth Circuit Today on Painkiller Issue

Wednesday, May 6th, 2009

A couple of weeks ago over at Hit & Run, Jacob Sullum blogged about a case in Kansas where the government seems to be targeting not only Stephen Schneider, a physician specializing in pain treatment and his wife Linda, but also Siobhan Reynolds, who heads up the pain patient advocacy group the Pain Relief Network.

Reynolds has become a sort of shoestring-budgeted PR machine for doctors under investigation whom she believes are getting railroaded. She educates local media on pain treatment, including the sometimes very high doses of medication needed to treat patients who have built up a tolerance to opiods. Her efforts in the Schneider case have resulted in some refreshingly balanced coverage. And that apparently has Assistant U.S. Attorney Tanya Treadway steaming.

As Sullum noted, last year Treadway tried to impose a gag order on Reynolds. She was denied. Several of Schneider’s patients who had spoken out on his behalf say shortly after, federal agents forced their way into their homes, in one case confiscating a letter Schneider had written from prison.

So Treadway is now calling Reynolds the “subject” of a grand jury investigation into possible obstruction of justice. Treadway has asked Reynolds to turn over all of her correspondence with pain patients, attorneys, the Schneiders, and just about everyone else in any way associated with the case. Reynolds is fighting the subpoena, and is now represented by the ACLU.

Last year, Treadway also attempted to bar the Schneiders from obtaining court-appointed counsel, citing their considerable wealth. The problem is that everything the Schneiders own is subject to forfeiture, meaning any attorney who agreed to take their case would do so knowing there would be a pretty good chance he’d never get paid. The government essentially argued that the accused couple should have no counsel in court (unless they could find someone to take the case pro bono), and be barred by law from having anyone defend them in public. When all of that failed, they asked for a change in venue, claiming that patients and Reynolds speaking out for the Schneiders had tainted the jury pool.

Treadway’s efforts are particularly egregious given that it has become pretty standard practice for U.S. attorneys to issue press releases and sometimes even call press conferences to announce when a physician has been indicted for over-prescribing painkillers—as they did in the Schneider case. The government can work the media and jury pool all it likes. But when a suspect gets an advocate who knows how to work the media, they first try to shut her up with a gag order, then intimidate her with a grand jury investigation.

But Treadway’s aggressiveness may well come back to bite her. Her office originally tried to link the Schneiders’ practice to 56 alleged patient overdose deaths. U.S. District Judge Monti Belot balked, and threw out all of the deaths but four. He then sternly warned Treadway not to appeal his decision. Belot also instructed the government not to use inflammatory descriptions like “pill mill” in front of the jury, another common tactic in these cases.

Treadway appealed anyway, delaying the Schneiders’ trial by months. The interesting thing is that her appeal allowed the defense to file a cross-appeal that will challenge not only Treadway’s attempt to link the Schneiders to the four remaining deaths, but also the government’s entire methodology of using “red flags” and questionable links to patient deaths to prosecute pain doctors. Reynolds, who has seen a lot of these cases, says it’s the first case she can recall where a federal appeals court will hear arguments on whether the government’s system of identifying what it says are drug diverting physicians is scientifically sound enough to be admitted into evidence.

One red flag the government uses, for example, is to look for physicians who simply prescribe a raw number of pills that investigators say is too high, a practice pain advocates say has made doctors afraid of engaging in the high-dose opiate therapy course of chronic pain treatment that’s been so effective. Other red flags include doctors who spend what investigators say is too little time with patients to make an accurate diagnosis, a problem pain advocates say has become increasingly common not because more doctors are selling scripts to addicts and drug dealers, but because the few doctors who do still treat chronic pain are overwhelmed with patients whose former doctors have been arrested, stripped of their licenses, or run out of business by investigations.

The Schneiders’ brief also argues that the government’s practice of linking deaths to opioids is problematic because such deaths often include patients who merely had high concentrations of opiates in their systems and died unexpectedly. Several of the patients who died of heart attacks, for example, weren’t checked for signs of heart disease. The heart attack plus a high concentration of opiods in their system was enough for the government to link the opiods to the heart attack.

The government’s argument that the Schneiders were causing a disproportionately high number of deaths also rests on comparing the number of clinic patients who died to the population at large, instead of to the number of patients undergoing treatment at a clinic not suspected of any wrongdoing. It isn’t all that difficult to see how patients undergoing treatment for chronic pain might have a higher mortality rate than the general population.

The federal government has been using these arguments to prosecute doctors for years, but to this point, there has never been a formal hearing to determine if there’s any actual science behind them. Pain specialists are skeptical. The general consensus is that red flags are fine for identifying potentially problematic doctors by, say, a medical board, but they’re simply not enough to find a doctor guilty of criminal wrongdoing. Pain specialist and pain organizations have also long decried the arbitrariness with which the red flags and ambiguous links to patient deaths are applied. Today, the U.S. Tenth Circuit Court of Appeals will hear their complaints.

There would be some poetic justice here if Treadway’s aggressive tactics in the Schneider case were to result not only in a fatal blow to her own cause, but in the Tenth Circuit becoming the first federal appeals court to call into question the very foundation of how the government builds its case against pain physicians.

My prior coverage of the pain issue here.

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66 Responses to “Big Hearing at the Tenth Circuit Today on Painkiller Issue”

  1. #1 |  paranoiastrksdp | 

    In the puritan / temperance mind, anything that alleviates pain is bad.

    Feeling good = bad
    Life sucking = good

    But it’s people who use drugs that have mental health problems..

    10 Bucks says Treadway likes getting spanked in a bedroom setting.

  2. #2 |  nemo | 

    A pity it’s not possible to make such people as her experience the horrible, continual and unrelenting pain many of the people she thinks she ‘serves’ by her crusade on their ‘behalf’ feel on a daily basis. Such an experience would forever alter her perceptions of what is ‘acceptable’ levels of medication required to alleviate such Hell-on-Earth.

  3. #3 |  Dave Krueger | 

    The ladder of success for a prosecutor is built from the bodies of the people’s lives they destroy.

  4. #4 |  Hamburgler007 | 

    The thing that really got to me was the attempt to bar the couple from court appointed public counsel. It’s like something out of Kafka, only for reals.

  5. #5 |  Zargon | 

    From the prosecutor’s point of view, she has nothing to lose and everything to gain, so why the hell not?

    Virtually all actual and potential losses are born by the government agent’s target. Virtually all actual and potential gains are collected by the government agent. This is not a coincidence, or limited to prosecutor-defendant relationships. It is standard operating procedure for virtually all government agent to schmuck interactions.

  6. #6 |  paranoiastrksdp | 

    How long before the trolls show up to tell us how prosecutors have a tough job in which they have to endure a lot of bullshit so we should let them do whatever they want?

  7. #7 |  Mike T | 

    When it comes to screwing over the public, prosecutors are the new police.

  8. #8 |  CSI | 

    In an earlier age I’m sure these prosecutors would have been hunting down heretics to burn at the stake. Beware of public officials who feel they are fighting against what they perceive as a moral evil.

  9. #9 |  Mike T | 

    In an earlier age I’m sure these prosecutors would have been hunting down heretics to burn at the stake. Beware of public officials who feel they are fighting against what they perceive as a moral evil.

    La plus ce change…

    The most famous inquisition, the Spanish Inquisition, was actually run by people like them. It had no legal authority over people who were openly Jewish or Muslim. Its stated mission was to hunt down the conversos, the fake Catholics who were actually Jews and Muslims trying to retain their lands and other holdings and who were disloyal to the crown.

    The moral of the story? There is nothing new under the sun.

  10. #10 |  JS | 

    Dave Krueger “The ladder of success for a prosecutor is built from the bodies of the people’s lives they destroy.”

    Awesome way to put it. I think about that guy Nifong who tried to put the Duke Lacross players away even though he knew they were innocent. I wonder how many of his prosecutions were of other innocent people?

    The thing is, some people have an economic motivation to hurt other people, they actually get promoted for it, prosecutors are one, cops another, but they actually can advance in their profession by hurting innocent people. There must be some way to change that or some safeguard against it.

  11. #11 |  Hamburgler007 | 

    All the more reason for prosecutors to be just as accountable to the bar like all the other lawyers. If you are a prosecutor, in a position to destroy someone, why the hell shouldn’t you be held to the same ethical standards?

  12. #12 |  BamBam | 

    All the more reason for prosecutors to be just as accountable to the bar like all the other lawyers. If you are a prosecutor, in a position to destroy someone, why the hell shouldn’t you be held to the same ethical standards?

    Because the same people (not literally, but those that came before them) make the rules by which they must play. The rest of us are told to follow rules set up by others on our behalf to protect us ….. and of course the children.

  13. #13 |  Price | 

    Dude…….you are really keeping us informed…wish this stuff made the Ed show.

  14. #14 |  pam | 

    #10, don’t prosecutors (lawyers) take some kind of oath to uphold the constitution and seek the truth? How archaic is that.

  15. #15 |  The Johnny Appleseed Of Crack | 

    Especially ridiculous in light of the fact that the alternative treatments (Ibuprofin, Aspirin, Naproxen) carry much greater health risks for many people. New guidelines by the American Geriatric Society essentially state that opiod treatment is preferable to NSAIDS in pain management for most elderly patients.

    http://www.americangeriatrics.org/education/executive_summary.shtml

  16. #16 |  chance | 

    “Other red flags include doctors who spend what investigators say is too little time with patients to make an accurate diagnosis,”

    Too little time to properly diagnose…you mean like practically every doctor I’ve ever had?

  17. #17 |  Dr. T | 

    The DEA and the USDJ are equal opportunity harassers. They don’t just target private practice docs; they also go after federally employed physicians at VA hospitals and clinics. Physicians I knew at the Memphis VA Medical Center were being investigated for their opiate prescribing patterns. Yes, they had the gall to prescribe opiates to veterans with chronic pain due to having their lower backs and legs crushed by explosives or having shrapnel imbedded in their vertebrae or having incurable cancers. The VA physicians learned how to avoid scrutiny: they stopped prescribing morphine, codeine, and oxycodone. Instead, they prescribed methadone. Methadone primarily is used to wean addicts off heroin, but it also is an opiate. However, since methadone isn’t usually prescribed for pain, the physicians had to guess at dosages, which often left their patients in too much pain until the next clinic visit. But, what do the DEA and USDJ assholes care about veterans in pain? They’re just probable terrorists, after all.

  18. #18 |  Michael | 

    Don’t fool yourself. If a doctor takes time with his patients, he is not going to make over 75 grand a year! That is unacceptable for most. And, for those of us who accepted it as a trade off for taking care of one of the most difficult patient populations (chronic pain patients) it seems, even nuts!

    But, it could be so rewarding to know you had relieved some suffering that no one else had even alleviated a little bit! To know that your pain care restored, even, one life to an acceptable quality again, was rewarding. But, that is a thing of the past for many of us caught up in the DEA’s war on doctors. (out of work pain doctor) In the end, more patients will suffer, the longer this craziness continues. It could likely be a lot more cost effective to use more opiates as well. But who will ever know when the DEA and prosecutors tell doctors how to practice medicine!

  19. #19 |  Brandon Bowers | 

    The ladder of success for a prosecutor is built from the bodies of the people’s lives they destroy.

    Can’t disagree with the thought, but can you contract “whose?” Doesn’t look right to me.

  20. #20 |  Tokin42 | 

    There is a little town outside of where I live where a small town doctor has been investigated multiple times by the DEA for violations involving scripts. When a local paper did a feel good story about him recently celebrating his 45 yrs of service, some people posted comments about rumors involving the doctor (another reason I hate small towns, people have nothing better to do than wonder what there neighbor is doing). To make a long story short, the DEA wants to know who posted those comments, to the papers credit they refused to divulge the peoples names. This doc has been investigated at least 5 times and now is facing another…

    http://www.bhcjournal.com/News/InsideScoop/tabid/259/Default.aspx?ArticleId=23882&PageNumber=1

  21. #21 |  ktc2 | 

    Yet another glorious drug war victory in the works!

  22. #22 |  Boyd Durkin | 

    Reading this story while thinking of Cindy McCain is very agitating.

  23. #23 |  Michael Chaney | 

    Radley, the part about the feds busting into former patients’ houses and taking stuff isn’t true. From the linked article:

    Meanwhile, former US Attorney Randy Rathbun, who is no longer associated with the office, says, “I don’t believe it. I doubt that is happening. That is simply not appropriate.”

    See. Randy doesn’t believe it, and he is a former US Attorney. He would know.

  24. #24 |  SJE | 

    With the wars in Iraq, Afghanistan etc, there are more people coming home in need of opiates to control the pain from burns, shrapnel, missing limbs etc. Why does the DEA hate our troops?

  25. #25 |  Red Green | 

    And, why did the US military allow 50,000 hectares of poppies to be grown in Afgahanistan ,right in plain sight? The world is going to use the stuff somehow.I can only hope that this particular prosecutor finds a glass ceiling at the top of that ladder.

  26. #26 |  ktc2 | 

    Nah, no glass ceiling for her. Grease the ladder and put a pack of rabid hungry wolves at the bottom.

  27. #27 |  Dave Krueger | 

    Blockquote>#19 Brandon Bowers

    The ladder of success for a prosecutor is built from the bodies of the people’s lives they destroy.

    Can’t disagree with the thought, but can you contract “whose?” Doesn’t look right to me.

    Hahaha! Usually when I make a mistake, the sentence becomes unintelligible. I wish they had an edit function here, because I do it a lot. How’s this?

    The ladder of success for a prosecutor is built from the bodies of the people whose lives they destroy.

  28. #28 |  Dave Krueger | 

    See what I mean?

  29. #29 |  Eric Seymour | 

    I’m strongly opposed to legalizing recreational drugs, and very skeptical about medicinal marijuana (particularly when advocates insist the medicinal stuff must be used in the same way as the recreational stuff). However, going after pain docs for prescribing “too many” meds is just insane. It’s not the business of prosecutors to determine what doses are appropriate for pain patients–that’s the business of medical boards and the FDA. Show me that a doctor is prescribing oxycodone for someone who isn’t sick or injured and I’ll agree that doc should be prosecuted. Otherwise, stay out of their medical practice!

  30. #30 |  MacGregory | 

    Welcome to America’s newest war. The war on prescription drugs. Police and prosectutors are now targeting certain counties in southern W.Va. I actually heard a state trooper say [paraphrase] ” Just look at these people. You can tell that they don’t need to be on any pain medication.”
    Thank-you for expert medical opinion Dr. Pigg. May I schedule an appointment? My ass is chapped.

  31. #31 |  Michael Chaney | 

    Eric, thanks for your opinion. Hopefully, you can see that it’s a pretty short drive from your opinion to “It’s not the business of prosecutors to determine what *drugs* are appropriate for pain patients–that’s the business of medical boards and the FDA.”

  32. #32 |  Dave Krueger | 

    I was going to say the FDA should be taken out and shot, but, I believe in due process, so we should try them for all the death and senseless suffering they’ve caused and then administer the appropriate penalty.

  33. #33 |  Bronwyn | 

    One of my colleagues routinely serves as an expert witness in trials, for both the defense and plaintiffs, doing forensic toxicology. He adds pharmacogenetic analyses when he can.

    For instance, a case of twin infant boys who had tonsillectomies and died after being given codeine; another case of a middle-aged woman on multiple medications who died.

    In some cases, it’s proven that a simple genetic variation caused someone to overdose at a standard dosage. Other times, the toxicology can show that co-medications combined with a genetic variation are to blame. And of course, sometimes there’s malpractice.

    The science is there, ready and available. It’s knowing whom to ask that may be a problem for some of these defenses.

    I’ve developed a test for opioid response and we’re assessing it now – so far, it looks good. Patients with the variant need greater dosages to achieve relief. It’s pretty cut and dry.

    The problem of developing tolerance, and the mechanism by which it occurs, is going to be trickier to figure out, but it’s a well-recognized phenomenon. It’s not popular with the feds, but anybody else with an inkling of knowledge understands it.

    I’ve tried to contact Reynolds in the past with little luck. Put her in touch with me if she wants to engage our assistance for anyone.

  34. #34 |  Purveyor of Iniquities › Links for May 7th | 

    [...] The Agitator » Blog Archive » Big Hearing at the Tenth Circuit Today on Painkiller IssueA couple of weeks ago over at Hit & Run, Jacob Sullum blogged about a case in Kansas where the government seems to be targeting not only Stephen Schneider, a physician specializing in pain treatment and his wife Linda, but also Siobhan Reynolds, who heads up the pain patient advocacy group the Pain Relief Network.(pain overcrim ) [...]

  35. #35 |  Dave Krueger | 

    #33 Bronwyn

    I’ve developed a test for opioid response and we’re assessing it now – so far, it looks good. Patients with the variant need greater dosages to achieve relief. It’s pretty cut and dry.

    The feds will probably want to know how you intend to keep people from faking the test results to ensure they get classified as needing higher dosages.

  36. #36 |  Eric Seymour | 

    Hopefully, you can see that it’s a pretty short drive from your opinion to “It’s not the business of prosecutors to determine what *drugs* are appropriate for pain patients–that’s the business of medical boards and the FDA.”

    Actually, I’d agree with that statement. I’ll even do you one better and take the FDA out of the loop. If large-scale, randomized, double-blind clinical trials show that currently-illegal drugs are equal to or better than current prescription drugs in safety and efficacy, I would support making them available by prescription.

  37. #37 |  Rick H. | 

    Of course, Eric, “safety and efficacy” conveniently leaves out any drugs which are consumed to get high. Under your formulation, self-medication is not a right. Neither is pleasure, even at the expense of no other person.

    You sound like a reasonable fellow, but I passionate disagree with the root of your argument – namely, that our bodies should be the exclusive property of the State.

  38. #38 |  Windy | 

    IMNSHO, this Treadway bitch should be hung by her thumbs, so her feet are well off the ground, for at least 24 hours; perhaps then she might have some compassion for intractable pain patients and the doctors who treat them.

    The government’s agents have done some really nasty things to people over the years (especially since Nixon’s “war on (some) drugs” started) but this one is definitely one of the most egregious.

  39. #39 |  Windy | 

    I want to add that I’m not at all in favor of ANY kind of torture, (especially to acquire information, since the info gained from such treatment is usually a lie), but this is one instance where it might actually do some good and teach the bitch a lesson she really needs to learn

  40. #40 |  Frank | 

    One of these days, a chronic pain patient is going to decide he can’t take it anymore and go after the head of the DEA or one of these prosecutors he (rightfully) believes is responsible for his continued pain. It will not end well for anyone.

  41. #41 |  Eric Seymour | 

    Rick H,

    I’m not going to get dragged into an argument over the legalization of recreational drugs, but I will respond to your straw-man argument against me. I do not believe that “our bodies should be the exclusive property of the State.” I simply recognize, as any mature, responsible person does, that virtually nothing an individual does affects only that individual. Unless one chooses to live the rest of his life as a hermit in some unpopulated area, his use of mind-altering substances will have an effect on his family, his friends, and his community. I believe it is proper for a free society to protect its members against the harmful externalities, if you will, of the choices of others.

  42. #42 |  BladeDoc | 

    If large-scale, randomized, double-blind clinical trials show that currently-illegal drugs are equal to or better than current prescription drugs in safety and efficacy, I would support making them available by prescription.

    Which trials are conveniently illegal to perform because the FDA has classified the drugs as Schedule I “no legal use”.

  43. #43 |  BladeDoc | 

    Damn I’m bad at html

  44. #44 |  Eric Seymour | 

    BladeDoc,

    Although no prescriptions may be written for Schedule I drugs, it is perfectly legal to use them for medical research with special approvals. See, for example, this web page from UC Irvine which provides guidelines for obtaining the necessary approvals (specifically, sections 3.b.ii and 5.b which mention Schedule I substances).

  45. #45 |  J sub D | 

    In various places on the intertubez I’ve used the terms War on –

    Sanity
    Minorties
    Liberty
    Freedom
    Human Nature
    Youth
    Brown People
    Justice
    Reality

    I will now add Terminally Ill to the playlist. *sigh*

  46. #46 |  MDGuy | 

    “Although no prescriptions may be written for Schedule I drugs, it is perfectly legal to use them for medical research with special approvals.”

    How often do you think they give those special approvals?

    “Our study aims to show that marijuana causes brain damage, homosexuality, and leprosy” APPROVED!

    “Our study is going to investigate marijuana’s potential to relieve nausea associated with chemotherapy” DENIED!!!!

  47. #47 |  MDGuy | 

    Eric, your argument is esentially one for complete paternalism. A father’s choice to watch TV for 7 hours everyday could be having an effect on his family. Should we arrest him for it? A mother’s decision to eat fast food everyday could affect her family’s finances when she needs a triple bypass. Should the state step in and intervene? John’s decision to divorce Jane has a negative effect on the kids; should we prohibit that as well?

    Your argument also ignores the “harmful externalities” created by a system of prohibition: black market violence, erosion of civil liberties, militarization of police, the list goes on and on. Not to mention the absurdity of “protecting” families by ripping them apart and sending a parent to prison.

    On top of that, prohibition isn’t even successful at what it aims to do, so it isn’t really protecting anyone from “harmful externalities,” it’s just creating more.

  48. #48 |  Eric Seymour | 

    MDGuy wrote:

    How often do you think they give those special approvals?

    Fairly often, actually. Just do a Google search on “clinical trials cannabis” and you’ll find a lot of results from trials which obviously must have been approved. In fact, the University of California has a Center for Medicinal Cannabis Research.

    I concede that I haven’t done much of my own research into medical uses of marijuana. My expressed skepticism (not opposition) was based on the fact that virtually everything I hear from marijuana advocates is entirely anecdotal. Which makes a certain amount of sense, since most advocates aren’t really interested in making cannabis available as a prescription drug; they want to make marijuana legal for people to use however they see fit. But if cannabis were shown to be safer and/or more effective than currently-available pain treatments, I’d have no objection to its medical use whatsoever.

  49. #49 |  Eric Seymour | 

    As to your “complete paternalism” argument, I never said that the government should prevent any and all harmful externalities of individuals’ choices on others. There is clearly a judgement call that must be made as to when intervention is necessary. My point was that Rick H’s assertion that a person’s choice to get high doesn’t affect anyone else is sophomoric.

    Again, I’m not here to argue whether or not recreational drugs should be legal, much less whether drug interdiction activities are just and rational (I think a lot of it is not). If you will recall, my original point was that even though I’m more in favor of drug prohibition than most of the readers of this blog, I completely agree that going after pain doctors without proof that they’re giving prescriptions to people who aren’t injured or sick is reprehensible.

  50. #50 |  MDGuy | 

    It is sophmoric to say that a person’s choice to get high doesn’t affect anyone else. It is also sophmoric to say that it will always 100% negatively affect others – experience proves otherwise. Alcohol, by any objective measure, is a more intoxicating, more addictive, and more dangerous drug than marijuana, and yet millions of people use it all the time without negatively affecting those around them. Granted, some people do negatively affect those around them through their choice to drink, but most people don’t. A policy of prohibition leaves no room at all for a judgment call on when intervention is necessary. As a result, the policy does more harm than it prevents because it criminalizes and institutionalizes people who don’t need to be treated as criminals and who don’t need to be locked up.

  51. #51 |  Rick H. | 

    Eric,
    My point was that Rick H’s assertion that a person’s choice to get high doesn’t affect anyone else is sophomoric.

    And what I actually said was:
    Under your formulation, self-medication is not a right. Neither is pleasure, even at the expense of no other person.

    I never asserted recreational drug use “doesn’t affect anyone else.” That’s a red herring anyway. We’re talking about drug prohibition by government force, not metaphysical notions of interrelatedness.

    Unless one chooses to live the rest of his life as a hermit in some unpopulated area, his use of mind-altering substances will have an effect on his family, his friends, and his community.

    I don’t think the DEA allows any exceptions for hermits.

  52. #52 |  Dave Krueger | 

    The sum total of all things people do that can affect adversely someone else is only minutely increased by adding legalization of drugs to that list.

    Furthermore, the philosophy of criminalizing something that will, under some circumstances, be misused by someone resulting in injury to another person is a bottomless pit by which government can justify anything it wants. There is no “judgment call” that determines where the line is drawn. The line constantly moves and it moves only in the direction of increased government intrusion into people’s lives.

    Finally, those injurious things that people do that affect other people, whether under the influence of drugs or not, are already covered by laws that come into play when an injury actually occurs.

    Criminalizing an activity that causes no one harm simply because it puts a person in a position to cause someone harm serves no purpose other than to make criminals out of non-criminals and give legislators something to list on their resume during the next election.

  53. #53 |  ACLU Backs Reynolds’ Motion to Quash | 

    [...] See also: Fed Prosecutor Tries to Silence Drug Policy Activist, Again – Sullum; 2009-04-17 Big Hearing in 10th Circuit on Painkiller Issue – Balko; 2009-05-06 Grand Jury Subpoenas Pain Relief Activist – Drug War Chronicle; [...]

  54. #54 |  Adina Cappell | 

    This whole ordeal is so sickening. As a medical student, I feel that I shouldn’t have to choose between worrying about my license and ensuring that my patients aren’t in agony.

    To me, it more dangerous and disturbing to undertreat pain than to overtreat it. I will provide my patients with the care that they need, according to sound medical judgment. This is more important to me than worrying about the vicious actions of some heartless bureaucrat.

  55. #55 |  Lloyd Flack | 

    It looks as if some drug warriors react in a hostile manner to any suggestion that they are not actually good people. They are on a crusade and anyone who opposes a crusade must be evil. And especially, anyone who claims that their zealotry is making them evil, why they must be in league with the devil.

    Treadway’s actions look like those of someone whose inflated self-image has been challenged.

  56. #56 |  Eric Seymour | 

    MDGuy wrote:

    It is sophmoric to say that a person’s choice to get high doesn’t affect anyone else. It is also sophmoric to say that it will always 100% negatively affect others

    Well, then, it’s a good thing I didn’t claim that it does. :)

    For the last time, I didn’t come here to start an argument over whether marijuana or any other drug should be legal or not. I only mentioned my anti-legalization stance on recreational drugs as a way to emphasize the fact that I agree with Radley that prosecuting pain doctors in the absence of clear evidence of wrongdoing is reprehensible.

    I’m not going to continue arguing with you, because it’s not achieving anything other than distracting attention from the issue we agree on.

  57. #57 |  James | 

    it’s not achieving anything other than distracting attention from the issue we agree on

    Exactly. Why you chose to bring up the non-relevant point in the first place is something you need to deal with. The discussion is about physicians who prescribe legally approved pain medication to treat patients with chronic pain and prosecutors, with no medical training, interceding in this process with their own non-medical judgments.

    Exactly why you chose to bring in the topic of schedule I drugs (that have no medical benefit) use in recreational activities has caused what it was intended to do. Get everyone off topic.

  58. #58 |  Nic | 

    Wow, thanks for covering this. I was a pain patient for years, I was prescribed (by DEA standards) high doses of opiates, however because of a single incident, I lost my doctor: because I came up positive on the pee tests that they make pain patients take every month. Occasionally, but very rarely, I smoked pot for the pain as well – but only when I was in so much pain that the prescribed dose of opiates was not enough, and only when I knew that I would not be tested for another few weeks, I was always okay, but apparently this one time, it was detected. I was put in a desperate situation because of these policies. I’m on disability because of illness, I’m no criminal, I’m not a drug dealer, and I’m not a drug seeker (not that it’s wrong to do drugs or seek out drugs), but my situation is simple: I’m just sick. But now because I have no doctor, and can’t get a doctor, I’m forced to buy my medicine off the streets at a much higher price. I was never a criminal to begin with, I’ve never had any run in with the law, but because of the DEA, the government and these policies they have forced me to become a criminal in order for be to obtain medication that simply allows me to get out of bed in the morning. It’s so f-ing unfair…I honestly hope every single one of these jerks prosecuting these doctors and sick patients, has either themselves or one of their own family members fall sick and in immense pain and then can’t get a doctor or the medicine they need because, low and behold, they arrested all the doctors and the ones who are left are too scared to prescribe anything. I’ve literally had doctors say to me, “I understand that you need this, but, I’m sorry, I can’t prescribe it because I don’t want to be harassed by the DEA.”

    And it’s total BS this crap about people being prescribed “too much” pain medicine. Well, that’s the way it f***ing works…patients REQUIRE more and more medication because there’s this whole thing called TOLERANCE. With opiates, you build up a tolerance and need more and more to treat the pain effectively…there’s no such thing as “too much”, there’s only the “effective dose”, and it’s on a case by case basis. The dose that I was taking would kill anyone who was “opiate naive”, but for me, it was a safe effective dose. And yes, unlike the propaganda says, opiates are one of the safest medications around so long as they are taken correctly. But the gov’t won’t ever admit to the fact that opiates (even diacetylmorphine) is both SAFE and EFFECTIVE, probably THE MOST safe and effective medication in existence for treating pain. But the gov’t apparently wants to keep doctors from treating people EFFECTIVELY. They would rather have the patient take an ineffective dose that the DEA deems to be an “appropriate amount” and have the patient suffer in pain all day and night, rather than allow the patient to take an EFFECTIVE amount so that maybe they could have a chance at living a decent life. This is such BS what they do to these doctors and the thousands of patients that rely on them. I wish something could be done…but what? Bunch of monsters these drug prohibitionists are…and that’s really the root of all this: drug hysteria and prohibition.

  59. #59 |  Nic | 

    One more thing, Radley, can you update us when you hear more about the results of this case? thx.

  60. #60 |  Lloyd Flack | 

    Tradway is accusing Reynolds of having a “syncophantic and parasitic relationship” with the Scheiders. Interesting the way she puts things. It looks as if she is using terminology with adiction overtones to describe people who oppose her. It looks as if she cannot or more likely will not allow herself to understand how decent people might oppose her.

    This appears to be about her self image as a champion of justice. If decent people oppose her then she might not be what she sees herself as. And of course that is not possible, is it?

  61. #61 |  MDGuy | 

    Ok Mr. Seymore, last argument I promise…I just can’t see how you don’t realize that the issue of recreational drugs IS related to this post. The whole reason they’re going after these doctors and doctors who prescribe pain medication in general is because of our zero tolerence, puritanical oppositition to people using drugs recreationally. In the minds of the drug warriors, the grim specter of someone, somewhere getting high for FUN (can you imagine?) off these pain medications justifies their overreaching control over what should be medical decisions and their persecution of the doctors in this case.

  62. #62 |  Mark Kellen | 

    As a practicing pain physician, I can tell you that I think of quitting every week. I realize that every time I write a prescription, I and my family are at risk of complete financial destruction at best, or at worst, of prison if some fed prosecutor gets a burr in their butt.

    We need to legalize these drugs, prohibition leads to gang violence and black markets. It gives the government more power and money, and we lose our civil liberties and freedoms more and more every day.

    Below is a link for more on the abuse of physicians by government agents.

    http://www.aapsonline.org/painman/pm-ppba.htm

  63. #63 |  Christine Blasbichler | 

    We will soon have to ask the federal government if we can take an aspirin. I sat through the trial of a dear friend, Dr. Robert Ignasiak, in Pensacola, FL in November 2008. He is now serving what amounts to life in prison. I was astounded (and disgusted) at the prosecutors for putting witnesses on the stand to testify against this doctor, when they admitted that they lied and doctor shopped in order to get prescriptions. They got a big hug from the prosecutors and a promise of financial gain (restitution) if the doctor was convicted. One of the jurors attended church with a DEA agent (on the case)- and the judge ruled against excusing him! I no longer have any faith in the criminal justice system. I certainly have no respect for some of these prosecutors. Shameful!

  64. #64 |  Ian MacLeod | 

    I wrote a lot on the PRN for a couple of years. I’ve been a chronic pain patient (CPP) for 7 years now, My wife was dying of COPD, and thanks to Bush era funding cuts, there was just me to care for her. Right about the time she became bed-ridden, the VA decided to panic and hand me over to a fake “pain management specialist” who was no such thing. They lied to me, blackmailed me, and one thing they led me to believe was that this was a “consult.” When I got there, he told me he was “taking over” my pain care and my PCP could no longer prescribe for the pain from 6 back operations and massive nerve damage. The first thing he did was destroy the regimen that had allowed me to function for 8 years, crippling me. He treated me like a criminal, ignored my home situation and kept trying to force me to drive 50 miles for just a piss test, when I told I couldn’t leave my wife alone. There was a choking danger, plus dementia (she fell and broke her shoulder once when I HAD to go the store. I finally had to leave the VA. We had decided on a double suicide. I couldn’t find pain care, my weight at 6’2″ was down 143 pounds and we were living in an increasingly toxic house I could no longer keep clean. I found a doctor who was willing to give me maybe 1/3 of my former regimen – not enough, but I stayed with her and did my best until she passed away in my arms, and she stayed in the home she’d grown up in until the end, as she had wished.

    Now the local VISN20, the guy in charge of 5 states of VA hospitals, has decided that no pain patient may have more than 160 mg of morphine equivalent (and those “equivalencies” are valueless when applied to different people, and meaningless in chronic pain anyway) per day. That is going to cripple the majority of the pain patients they’re treating. Even the W.H.O. says, “The correct dose is the one that works.” And the VA’s former Directive on CP treatment agreed with current science: opiates have no severe upper limit. You titrate to pain and function. Sheer numbers of pills or milligrams per dose mean nothing except in terms of the patient function and quality of life.

    I can guarantee you there will be more suicides because of this. And something else you never hear: there are an estimated 75 MILLION CPPs in the US who are under-treated or entirely UN-treated. As pain treatment gets worse, as Baby Boomers age, as more vets come home and THEIR pain goes untreated, that number will skyrocket, and the shortage of doctors will become impossible. Most of us are, as Dr. Fisher said, “Medical train wrecks.” We have conditions secondary to the pain, which is now classed as a disease process in and of itself. In short, we’re dying out here, slowly, in poverty and agony. A woman I know has been sentenced to death by her insurance company which no longer chooses to pay for her pain meds. She has a disease the destroys cartilage, and if her pain runs out of control, her BP shoots up and she’s vulnerable to tracheal collapse, clots and so heart attacks, strokes and pulmonary embolism. Or she can bleed out through damaged vessel walls or have a stroke that way. (The disease is relapsing polychondritis). We’re profitable to the DEA and DOJ, you see, when we’re suffering. And the private prison industry. We’re great material for justifying the Drug War, and Drug War funding (60 billion per year and climbing), plus the DEA gets great media coverage, and they can keep funds from civil forfeitures. And we’re only a bunch druggie cripples just a breath away from being street people. Who cares?

    Not Treadway; that’s for damned sure!

    Ian MacLeod

  65. #65 |  Ian MacLeod | 

    For what it’s worth, I’ve seen prosecutors get like this before. It becomes personal to them. As far as they’re concerned they’re trying to put criminals behind bars, not just trying to find the evidence to prove that people who are presumed innocent are actually guilty. So keeping them in jail however it can be done is only what they deserve, convicted or not, and and even falsifying evidence, if it can be gotten away with, is just fine too. After all, if she’s prosecuting them, they MUST be criminals. Right? She’s trying to protect the public, and not incidentally further her own career. So to people with this mind set, “win at all costs” comes to make sense. That’s IF she’s not just another rabid careerist who could care less how many innocent people she destroys. Both types, however, are no longer concerned with “justice” however, and need to be gotten rid of!

    Ian

  66. #66 |  The Alarmingly Secretive Persecution of Siobhan Reynolds | The Agitator | 

    [...] I posted here last year on Assistant U.S. Attorney Tonya Treadway’s vendetta against pain patient advocate Siobhan Reynolds. Reynolds’ transgression was to publicly question Treadway’s prosecution of Kansas pain specialist Steven Schneider and his wife. [...]

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