It is increasingly the case that Federal law enforcement agents in the employ of the U.S. Drug Enforcement Agency (the DEA) are inserting themselves into the practice of medicine by establishing the limits of certain pain control medication which physicians may prescribe for their patients. By what education and training are those agents qualified to participate in the determination of how much pain medication an unquestionably suffering patient requires to allow them to at least approach a normal level of functioning? I would suggest that the appropriate person to determine the level of pain medication required by a patient is the physician. Individuals experience pain from virtually identical injuries in myriad different ways and at myriad different intensities. IMHO, for a patient with pain resulting from physical injury, the individual’s level of pain is in some significant part unique and dependent upon what is likely a number of variables. This must make the determination of medication type and dosage a matter primarily for the prescribing physician, admittedly involving some degree of trial and error with feedback from the patient. I see almost NO place for the DEA to be involved in the process.

Any readers of this blog post who think all individuals respond to pharmacological substances in anything approaching an identical (or even near-identical) manner, are woefully ignorant of individual variability. To cite but one example, my own experience shows at least one source of variability. I smoked (mostly cigarettes, but at times a pipe) from the ages of 17 to 47, typically smoking one or more packs of unfiltered cigarettes during that period. At the age of 47 I had a mild myocardial infarction and I decided to quit smoking altogether. I expected to experience some sort of withdrawal symptons. However, while in the hospital a friend dropped off a book from a prominent cardiologist who mentioned in one brief passage that he had been surprised by the number of his patients who smoked who discovered by quitting that they were not addicted to nicotine at all. Rather, the cigarette  (or pipe, or cigar) turned out to be a prop in a ritual by which they resolved internal tension. Upon reading that passage, I immediately drew an imaginary cigarette to my mouth, inhaled and then exhaled and found that the sensation I had always interpreted as “needing a cigarette” was, in reality, simply needing to take a lungful of fresh air and exhale. I had always been a person who tended to intense concentrated focus on whatever I was doing. The result of that pattern of behavior was that I often forgot to breathe deeply until after the period of concentrated focus was completed. In the Hospital at that point I had quit smoking because I recognized the actual source of the perceived need,–namely the need to replace the carbon dioxide laden air in my lungs with some fresher air containing fresh oxygen.

My overall conclusion is that the DEA needs to get out of the space between the physician and the patient, unless there exists unimpeachable evidence of unethical conduct on the part of the physician, one example of which would be selling controlled substances to a drug dealer.

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