THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Monday, October 21, 1996 TAG: 9610210029
SECTION: LOCAL PAGE: B1 EDITION: NORTH CAROLINA
SOURCE: ASSOCIATED PRESS
DATELINE: RALEIGH LENGTH: 64 lines
The North Carolina Medical Board is reversing one of its guidelines for physicians and endorsing the use of powerful narcotics to manage chronic pain.
The board explained in a policy statement distributed last week that doctors should consider using the powerful painkillers when the narcotics would end suffering previously considered untreatable. The board, which oversees the conduct of the state's physicians, emphasized that it does not endorse casual use of narcotics like morphine, codeine and fentanyl.
The policy shift is a response to growing evidence that drugs derived from opium are more rarely addictive than once thought. They also can be the only source of effective pain relief for people disabled by maladies ranging from arthritis to nerve damage. Intense, constant pain has led some patients to commit suicide.
``This is really wonderful,'' said Eyssel Gurganus of Halifax County, regional director of a patients' group called the National Chronic Pain Outreach Association. ``It will make doctors who are educated about pain less afraid. And I hope it will prompt doctors who don't know about it to get curious.''
Doctors have avoided prescribing narcotics because they wrongly feared turning patients into addicts. Though patients do become physically dependent on the drugs, it is very rare for them to get intoxicated or crave the drugs for pleasure, said Dr. Alan Spanos, a pain expert who practices in Raleigh and Chapel Hill.
``Doctors routinely accuse patients of being drug addicts simply because they plead for the drugs,'' Spanos said. ``It's a visceral response based on a fear of street drugs.''
Physicians also steer patients away from narcotics to avoid added scrutiny.
Doctors know that state medical board investigators and the federal Drug Enforcement Administration monitor pharmacies to see which doctors prescribe a lot of narcotics. Investigators may show up demanding to review medical records if they think something is wrong. Doctors who cannot prove they are prescribing the drugs properly risk a warning from the board or loss of their license.
Such oversight is necessary because there is a vigorous black market for prescription narcotics. For example, a single tablet of the narcotic analgesic dilaudid can command $25 on the street, said Judett Black, a DEA supervisor in Greensboro.
In the coming months, the medical board plans to monitor arrestsfor street sales of prescription drugs to see if there is a detectable increase. It also will watch to see if demand for drug treatment services rises.
Narcotics should be reserved for only a small number of people with chronic pain, said Dr. Gerald Aronoff of Charlotte, the incoming president of the American Academy of Pain Medicine. They are the best choice when there is no other option for patients who have no history of drug abuse and can be closely monitored for side effects.
The North Carolina Medical Board plans a statewide educational campaign to teach medical workers about the merits of narcotic painkillers.
``We want to help without doing harm,'' said Dr. Charles Trado, a Hickory psychiatrist and medical board member. Trado encouraged the board to act after learning that investigators routinely monitor doctors who prescribe narcotics.
Medical boards in Texas, California and elsewhere have taken a similar stand. Legislatures in five states have passed laws emphasizing that it is legal to prescribe narcotic drugs for medically valid reasons. by CNB