I found Dr. DeLuca’s website through Zyp Czyk’s post:
The website is no longer in operation, but it’s an excellent look at the history of the drug war and how it infiltrated the medical industry, especially State Medical Boards. I lived in Texas when the first Intractable Pain Act was passed — in other words, I’ve lived this history. And reading the posts on this website is like going back in time and reliving my own history — so many of the stories from chronic pain patients include parts of my own struggles.
I remember learning about Dr. Hurwitz’s case. I remember the fear and anger it invoked in my doctor. I don’t think Dr. Hurwitz’s case was the first “success” of the DEA and a State Medical Board, but it was the one that got the most media attention — and the most attention from other doctors. Since then, State Medical Boards have basically become deputized by the DEA, along with many other state health agencies. Everyone in the medical industry pretty much works for the DEA, in one way or another.
Looking at the overall view of the war against pain patients, it’s informative to see how bad it’s gotten in such a short time. And it’s important to look at the war from other viewpoints, including those of doctors and the DEA.
David Covillion finally got relief from his pain with the help of Jack Kevorkian. The pain came from neck and back injuries Covillion had suffered in April 1987, when his station wagon was broadsided by a school bus at an intersection in Hillside, New Jersey. The crash compounded damage already caused by an on-the-job injury and a bicycle accident. Covillion, a former police officer living in upstate New York, underwent surgery that fall, but it only made the pain worse. Along with a muscle relaxant and an anti-inflammatory drug, his doctor prescribed Percocet, a combination of acetaminophen and the narcotic oxycodone, for the pain.
The doctor was uneasy about the Percocet prescriptions. In New York, as in eight other states, physicians have to write prescriptions for Schedule II drugs–a category that includes most narcotics–on special multiple-copy forms. The doctor keeps one copy, the patient takes the original to the pharmacy, and another copy goes to the state. After a year or so, Covillion recalled in an interview, his doctor started saying, “I’ve got to get you off these drugs. It’s raising red flags.” Covillion continued to demand painkiller, and eventually the doctor accused him of harassment and terminated their relationship.
“Then the nightmare really began,” Covillion said. “As I ran out of medication, I was confined to my bed totally, because it hurt to move….At times I’d have liked to just take an ax and chop my arm right off, because the pain got so bad, but I would have had to take half of my neck with it.” He started going from doctor to doctor. Many said they did not write narcotic prescriptions. Others would initially prescribe pain medication for him, but soon they would get nervous. “I’d find a doctor who would treat me for a little while,” he said. “Then he’d make up an excuse to get rid of me.” Eventually, Covillion went through all the doctors in the phone book. That’s when he decided to call Kevorkian…
Hurwitz may not be the only physician in the country who is willing to prescribe narcotics for chronic pain, but there are few enough that patients travel hundreds of miles to see them. “I call it the Painful Underground Railroad,” says Dr. Harvey L. Rose, a Carmichael, California, family practitioner who, like Hurwitz, once battled state regulators who accused him of excessive prescribing. “These are people who are hurting, who have to go out of state in order to find a doctor. We still get calls from all over the country: ‘My doctor won’t give me any pain medicine.’ Or, ‘My doctor died, and the new doctor won’t touch me.’ These people are desperate.”
So desperate that, like Covillion, many contemplate or attempt suicide. In an unpublished paper, Rose tells the stories of several such patients. A 28-year-old man who underwent lumbar disk surgery after an accident at work was left with persistent pain in one leg. His doctor refused to prescribe a strong painkiller, giving him an antidepressant instead. After seeking relief from alcohol and street drugs, the man hanged himself in his garage. A 37-year-old woman who suffered from severe migraines and muscle pain unsuccessfully sought Percocet, the only drug that seemed to work, from several physicians. At one point the pain was so bad that she put a gun to her head and pulled the trigger, unaware that her husband had recently removed the bullets. A 78- year-old woman with degenerative cervical disk disease suffered from chronic back pain after undergoing surgery. A series of physicians gave her small amounts of narcotics, but not enough to relieve her pain. She tried to kill herself four times–slashing her wrists, taking overdoses of Valium and heart medication, and getting into a bathtub with an electric mixer–before she became one of Rose’s patients and started getting sufficient doses of painkiller.
Clinicians and researchers have long remarked on the link between opiophobia and undertreatment of pain. In a 1966 pharmacology textbook, the psychiatrist Jerome H. Jaffe, who later became Richard Nixon’s drug czar, noted that patients who take narcotics long enough develop tolerance (a need for larger doses to achieve the same effect) and physical dependence (resulting in withdrawal symptoms). But he cautioned that “such considerations should not in any way prevent the physician from fulfilling his primary obligation to ease the patient’s discomfort. The physician should not wait until the pain becomes agonizing; no patient should ever wish for death because of his physician’s reluctance to use adequate amounts of potent narcotics.” ...
Meanwhile, Hurwitz’s patients were left high and dry. “I’m flabbergasted,” he told The Washington Post after his Virginia license was revoked. “The Board of Medicine has told my patients, ‘Drop dead.’” Said Laura D. Cooper, a patient with multiple sclerosis: “The board has made no provision for the patients. If I can’t get medicine, I’m going to die the next time I get sick, and that’s not histrionics. Some of us are candidates for suicide right now.” Cooper, an attorney, has filed a federal class-action suit against the Virginia Board of Medicine, the Department of Health Professions, and the DEA on behalf of herself and Hurwitz’s other pain patients.
David Covillion is not a party to the suit. He killed himself on September 11.
(Photo taken on 8/5/2015.)