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Doctors Seek Easing Pain Medication Restrictions

By: Sarah Karp
State Capital Bureau

February 15, 1995

JEFFERSON CITY _ Douglas Westoff, a Jefferson City doctor, has seen people in chronic pain unable to get the drugs they need. The problem: Doctors, weary of investigation, shy away from prescribing controllable substances, he said.

However, these controllable substances might be the only hope of relief for people wrought with intractable pain _ uncurable pain that doesn't stem from a terminal condition. Physicians usually do not worry about prescribing controllable substances to patients with terminal illnesses because the person has a limited life expectancy, Westoff said.

"Physicians have recognized that we have a public health problem with chronic pain and we are afraid to treat it," Westoff said.

Westoff wants the Missouri legislature to pass a bill to give doctors more leeway when prescribing controllable substances. In exchange, doctors would be instructed to keep detailed accounts of when, to whom and why they prescribed the controllable substance.

If the bill was approved, doctors couldn't be investigated solely because they prescribe controllable substances to patients with intractable pain.

At two public hearings held on the proposed legislation, no one testified against the bill. Further, most major medical associations, along with the state's Bureau of Narcotics and Dangerous Drugs, were instrumental in writing the bill.

However, those who treat drug abuse worry that relaxing regulation might be an open invitation to drug addicts.

"It would increase accessibility of prescribed drugs and that is always a factor in drug addiction," said Anita Kiessling-Caver, Clinic Coordinator at Family Counseling Center Inc. in Jefferson City.

"This bill could do both good and bad," she said. "I would hate to see people in chronic pain unable to get the drugs they need. But it could make it easier for an addict to manipulate the system."

Currently, whenever a doctor writes a large number of prescriptions for a controlled substance, the State Healing Arts Board, which licenses physicans, is compelled to inquire.

When J. Hill Morris, a doctor, was censored by the board for prescribing a controllable substance, he lost his license for six months.

Morris said he had been treating a young man who was suffering from severe neck and back pain. But that the board took action against him because he reported that the patient was abusing the drug.

"I checked the box for abuse because the patient had a physiological dependency on the drug," Morris said. "I was slowly trying to reduce the medication."

Now, Morris refuses to treat patients who need controllable substances.

"It is critically important to realize that patients are being denied these drugs by physicians because physicians are fearful of being censored from the board," he said. "If this bill passes, physicians will not be held responsible for physiology dependency."

The difference between addicts and people physiology dependent is that addicts use drugs for nontherapeutic reasons, said August Geise, president of the Healing Arts Board.

"People can be dependent on substances, small amounts of which keep them functioning," he said.