THE IMPACT OF THE PAIN RELIEF PROMOTION ACT ON THE PROVISION OF PAIN MEDICATION

H.R. 2260 Will INCREASE Doctors' Willingness to Prescribe Pain Drugs
Current federal law and regulations do not protect "double effect" pain relief prescriptions - - that is, they do not allow doctors to provide prescriptions even when they may increase the risk of death provided they are not prescribed with the purpose of causing death. For the first time, the bill inserts this protection in the Controlled Substances Act.

In the words of the American Medical Association (AMA), "This is a vital element in creating a legal environment in which physicians may administer appropriate pain care for patients." When similar language was enacted in new state laws that prevent assisting suicide, morphine usage per capita went UP (Iowa 1996, Kansas 1998, Louisiana 1995, Rhode Island 1995, Tennessee 1993, Virginia 1998).

The bill makes it more difficult than is now the case to revoke a doctor's registration to prescribe controlled substances for pain relief. It accomplishes this by raising the required standard of proof needed to call into question a doctor's statement that his/her prescription was for the purpose of pain relief.

H.R. 2260 CANNOT "Chill" Pain Relief in Comparison to Current Law
At present, under the same June 5, 1998, ruling by Attorney General Janet Reno that allowed the use of federally controlled drugs to kill patients whose suicides are assisted in accordance with Oregon state law, the Drug Enforcement Administration (DEA) may nonetheless revoke the registration of any doctor who uses federally controlled substances to assist suicide "in a state that has not authorized the practice under any conditions." Thus, in 49 states the bill does not increase at all the DEA's existing authority. Therefore, in all states other than Oregon, the only effect of the bill will be to reduce, and not increase, any " chilling effect" on the prescription of pain medication.

But will it increase a "chilling effect" on pain relief in Oregon? No.

First, it is important to understand the DEA's already existing authority with respect to doctors' registrations in Oregon.

Under Attorney General Reno's ruling, the DEA may already revoke doctors' registrations for using federally controlled substances to assist suicides "where a physician fails to comply with state procedures in doing so." Thus, under the bill there is no increase in the DEA's authority with regard to doctor-assisted suicide of non-terminally ill people, or in any other case in which the Oregon law is not followed.

Second, even in the circumstances in which the bill increases the DEA's authority in Oregon, beyond what already exists under current law, it can and will be enforced without any increase in DEA scrutiny of physicians' pain prescribing practices. That is because under the current practice, established by Attorney General Reno, only those doctors who comply with Oregon law are now exempt. And to compile with Oregon law, doctors must report to Oregon authorities both that they intend to assist suicide and what drugs they will use.

That means enforcement of the bill in Oregon will be achieved solely by subpoenaing reports required by state law, and NOT by additional investigation of doctors' prescribing practices. So EVEN IN OREGON the only effect of the bill will be to reduce, and not increase, any "chilling effect" on pain medication prescription.

H.R. 2260 Will Increase the Availability of Good Pain Management
The bill establishes a program to collect and widely disseminate protocols and practices regarding pain management and palliative care. It establishes a grant program to foster training of health care professionals in pain management and palliative care. Five million dollars is authorized annually for these programs.