My Letter to the DEA

[Robby]

In response to a story I read a couple of weeks ago about Dr.'s leaving the pain management area because of pressure from the government, and the DEA's comments about how they are protecting the public from harmful drugs, I sent an email to the DEA's comment line explaining my situation and how not only the problems I have, but the problems people I know face in getting pain meds. I finally received a reply to my comments and I wanted to share it with y'all. I specifically mentioned how I could not get enough medication to relieve my pain because the Dr's would not take a chance on losing their license by over-prescribing. How, we are treated like criminals every time we go to see the pain clinic, because they can't take a chance that we have done something they don't know about, and that puts us in constant fear of being labeled a drug seeker and losing all access to pain meds/treatment, just because the Dr.'s are afraid of going to jail. I made a point to mention that it's not the Dr.'s fault and I don't blame them at all, if I was in their position dealing with the DEA I would do the same things they are doing. They know that one wrong thing in a chart, one badly written note could have them raided, shut-down, and the loss of their license. This wasn't all I pointed out, but just the major points.

This was the response...

Dear Mr. Kitchen:

     I am very sorry to hear of your difficulties with the pain you are experiencing in your life.  Contrary to what you may have heard, the DEA does not get involved with the legitimate practice of medicine.  The practice of medicine is overseen by your Doctor and the State Medical Board in the state in which you currently are living.  There also may be other state laws, regulations, and/or insurance company restrictions on pain medications (controlled substances) that are not controlled by the Drug Enforcement Administration (DEA).

     The DEA has consistently supported the prescribing and dispensing of controlled substances for the legitimate treatment of pain within acceptable medical standards.  This is outlined in the statement of policy the DEA published in the Federal Register on September 6, 2006, titled, Dispensing Controlled Substances for the Treatment of Pain.  This statement of policy is available on the DEA Office of Diversion Control Website at www.deadiversion.usdoj.gov.  See attached "Dispensing Controlled Substances for the Treatment of Pain."


     Under Federal law and regulation "A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.  The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription."  Title 21, Code of Federal Regulations, Section 1306.04(a).

     Although DEA does not get involved with the legitimate practice of medicine, under Federal law and regulation, there are some options which you may not be aware of, that, if your practitioner (Doctor) agrees, and your state law permits, may make it easier to obtain the medications you need.  Some of those options are as follows:

·         Under Federal law and regulations an individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of the same Schedule II controlled substance.  See attached Title 21, Code of Federal Regulations (CFR), §1306.12(b) (1).  Also see attached "Issuance of Multiple Prescriptions Final Rule 2007-11-19.



·         Under Federal law and regulations there is nothing which would prohibit an individual practitioner from issuing a single prescription for a 90 day supply. 



·         Under Federal law and regulations practitioners may issue electronic prescriptions (under Federal regulations under EPCS) to the patient's pharmacy for pick-up by the patient.  21 CFR 1311.100 (b)



·         Under Federal law and regulations there is nothing which would prohibit your practitioner from mailing written prescriptions to their patients or the patient's pharmacy.



·         Under Federal law and regulations there is nothing which would prohibit pharmacies from mailing a patient's filled prescription (medication) to the patient's home address.



·         Under Federal law and regulations an individual practitioner may fax a Schedule II prescription to the pharmacy provided that the original paper prescription is given to the pharmacist prior to dispensing.  21 CFR 1306.11(a)



·         Under Federal law and DEA regulations an individual practitioner may fax a Schedule III, IV, or V prescription to the pharmacy.  21 C.F.R. 1306.21 (a)



     Federal law and DEA regulations do not impose a specific quantitative minimum or maximum limit on the amount of medication that may be prescribed on a single prescription, or the duration of treatment intended with the prescribed controlled substance.  However, the CSA and implementing regulations require all controlled substance prescriptions to be "valid."  A prescription is not "valid" unless it is issued for a legitimate medical purpose within the usual course of professional practice.


     The DEA routinely works with registrants to ensure an adequate and uninterrupted supply of pharmaceutical controlled substances and listed chemicals is available to meet the legitimate medical, commercial, and scientific needs of the United States.  However, the DEA has no authority to direct what a company must manufacture or distribute, how much to manufacture or distribute, when to introduce such products into the supply chain, or what products a company can legitimately sell to its customers.


Although the DEA is the agency responsible for administering the CSA, the DEA does not act as the federal equivalent of a state medical board overseeing the general practice of medicine and lacks the authority to issue guidelines that constitute advice relating to the general practice of medicine.  Therefore it is important to check with the Board of Medicine and Board of Pharmacy in the state in which you are located in order to determine whether there have been any changes to state law or regulations that may be affecting your ability to obtain pain medication.  States are permitted to impose legal requirements beyond what federal law and regulations require, such as limiting the supply of medication to 30 days per prescription, or limiting the quantity that in-state or out-of-state wholesalers may distribute to a pharmacy.  In addition, your insurance company or physician may choose to adopt business practices that affect your ability to obtain pain medication.

James "Jim" Arnold
Chief of Policy
Office of Diversion Control
DEA Headquarters
600 Army-Navy Drive
Arlington, Virginia 22202
202-353-1414 (Desk)

     

[Lonesome George]

Bull

[denny]

Blame it on the state I guess.
Seems down right anti californian what there doing to me.

[Lonesome George]

If it's a state thing, why do I keep reading the same bad reports about pain clinics in most every state.

[looneylane]

Sounds like a passing of the buck...

[ronr]

Passing the buck is exactly what I thought.

Write to the state board and insurance company and  I bet they will try to blame someone else also.

[DEL]

BOHICA!!!

[looneylane]

They will just keep throwing each other under the bus

[foxgrove]

Pass the buck... sounds more like hot potato to me!!  They couldn't wait to get rid of you so they fobbed off the party lies in a letter.  What a bunch of whimps... they can't even take responsibility for the damage they inflict on those in pain.  Wow!!   

[denny]

I don't see it.
Are they lieing in that letter?
God bless the dence,for they are the uncomprehening.

[mloved]

Good job Robby

I guess you could take a copy of James Arnold's letter to the drs and pharmacist (in a very non confronting, polite, asking for their input).  Write down what they say - see if they'll sign it - they probably won't, but that'll be ok.  And or, if willing, you can write another letter telling what you did, the run around you got, and send it with copies of the other letter you wrote and the one you received from James Arnold to your state representatives and senators,.

In the past, I wrote mine, and the president - think it was Nixon, on another matter.  They all did leg work, gave me info on who to contact, and did some stuff, stuff got done.  I was surprised - the president's assistant gave us a congressional order.  It was amazing.

Not saying today's people will do anything but it's worth a try.  Others here can also use that James Arnold letter to do the same.  Not sure if I made any sense  

[Robby]

moved, perfect sense. That was a direction I had not thought about.

[ronr]

Keep a copy of each letter blaming another agency.  That way you will have a compilation to send to all the other agencies that say it's someone else's fault.  See what they say when you can show a letter that each of the other agencies says.  Hope that makes some sense.

[looneylane]

What ronr said

[mloved]

oops - I assumed only copies would be used and never the originals.  My bad, fog/cog/dyslexia    For clarity, archives, fogs, cogs etcs, I'll edit my post to specify "copy".

[ronr]

Don't worry about editing past post mloved.  Too much work - too little to gain, and we know what you meant anyways.

[Barberian]

I suggest also once you have a series of letters from the various agencies and companies, to find a news organization that will take your story and have it published/presented.

[foxgrove]

Oooooo that would be sweet to see the spin doctors in their bunch sweat for a little while.  That's really all it is... the fact that what they said in the letter may in fact be factual, it doesn't take into account that the DEA uses fear as a tactic to make sure that the medical system toes the government line.

Very good idea mloved!!! 

[ronr]

I suggest also once you have a series of letters from the various agencies and companies, to find a news organization that will take your story and have it published/presented.

Great Idea !