It’s not that the Drug Enforcement Administration is always looking for a silver bullet.  It’s that they just don’t care about collateral damage.

The  Wall Street Journal, via Volokh, has an important piece about the DEAs newest and brightest idea for dealing with prescription drug abuse.  While the illegal abuse of such narcotics as OxyContin, Rush Limbaugh’sdrug of choice, on the government’s radar since the overdose death of Heath Ledger, it should come as no surprise that our law enforcement heroes want to rush in and save the day, albeit a day late. 

While it is their intention to investigate, a word that strikes fear in the hearts of any potential target, those doctors who prescribe medications “inappropriately,” whatever that means, it’s not enough to sate the hunger to win the war on whatever war we’re waging today. 

Rather, the DEA has chosen to pursue an affirmative attack on prescription medications, and it just happens that the only people standing between it and victory are physicians.  And patients.

For one thing, they prompt some law-abiding doctors to think twice before writing legitimate scripts. A 2001 study of California doctors found that 40% of primary-care physicians said fear of investigation affected how they treated chronic pain. A recent survey of physicians by the Center for Addiction and Substance Abuse found that one-third worry “a great deal” or “somewhat” about review of their own prescribing of controlled drugs by law enforcement agencies; and 44% report that this actually influences which medications they prescribe.

The expansion of DEA regulatory authority could slow development of improved medicines, by chasing away companies that fear added uncertainty about whether new products will get approved. This includes new generations of narcotics more resistant to abuse. It would actually be better for the public if the FDA made these abuse-resistant painkillers immediately eligible for priority review, which can shave time and cost off the development process.

How do you feel about having your local DEA agent sitting in the examination room, giving the thumbs up or down to the doctor’s prescription?  I’m not too keen on the idea.

While much of the efforts of the criminal defense bar is directed toward the overkill of punishment for drugs that has put so many people in prison while accomplishing so little, it’s largely addressed street drugs, from crack to marijuana.  Now they’re getting into the choices made by doctors and patients, with the express intention of chilling the choices a physician will make in prescribing medications.  Better that patients are not properly treated than prescription drugs fall into the wrong hands.

The issue is not whether it’s okay to have prescription drugs abused.  The issue is how the government decides to deal with it.  Since the DEA has never been good at, nor to my knowledge considered, a surgical approach to problems, they plan to come in with a big club and beat docs over the heads for doing their jobs.  Are there some docs who deserve to be investigated?  I’m sure there are, though I can’t say that I know any personally.  But I’ve represented numerous physicians, and would be more than happy to defend a few more, as the DEA will no doubt plow into physicians with the same mindset that they have with street dealers.

But interfering with, and causing physicians to withhold, needed medication from patients for fear of the DEA breaking down their door has the potential to cause a lot of harm to our health care.  And we have enough problems with health care already.  We shouldn’t need the DEA’s permission to receive treatment.