U.S News & World Report March 17, 1997

Caught in pain's vicious cycle

He helped his patients--and lost his license

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Linda Tolen lost her life twice. In 1990, searing pain from a herniated back disk robbed the South Carolina court reporter of her job, night school, even the ability to walk. After four housebound years, 30 doctors, and $100,000 in medical bills, Tolen found William Hurwitz, a maverick internist who was willing to prescribe enough morphine to ease the pain. Within two weeks, she was back at work and school, acting like a kid at Christmas. "There weren't enough hours in the day for all the dreams I was reviving," she recalls. But last August, just weeks after Tolen earned a 25 percent raise and started to pay off debts, Hurwitz lost his medical license. Without medication, Tolen is again jobless and using a wheelchair. "I want my life back," says the 40-year-old. "But I can't imagine making it to my next birthday in this pain."

Tolen is one of thousands of chronic-pain sufferers denied help because relief happens to come from a controlled substance. Hurwitz treated over 200 patients, and in the months since the Virginia Board of Medicine stripped him of his license on the grounds that his practice was too risky and his monitoring of patients inadequate, two of his patients have committed suicide. One, David Covillion, videotaped a suicide message: On the tape, he called other doctors "scared wimps" for refusing to treat him. Many physicians are fearful. Over 100 doctors who prescribe narcotics lose their licenses each year, and 40 percent of pain specialists admit that they undermedicate patients to avoid trouble.

The result is a vicious cycle. Because so few doctors treat chronic pain with narcotics, those who will are asked to help a deluge of patients under less than ideal circumstances. Hurwitz had patients as far away as Florida and Washington--a distance that fueled the medical board's objections. Hurwitz says he couldn't find it in his heart to turn them away. After failed attempts to match patients with local doctors, he says, "I couldn't just say `Sorry buddy, drop dead.'"

With so many patients, something was bound to go wrong for Hurwitz, and it did. In January 1996, one man using narcotics for pain from a head injury died. A week later, a second patient died after she overdosed on medication. The deaths, and fears that some patients were abusing or selling drugs, prompted the state licensing agency to hold hearings. Although Hurwitz was not blamed for the deaths, and leading pain experts testified in his defense, the board revoked his license and told patients to seek help elsewhere.

Beyond pain. But some patients have nowhere else to go. Laura Cooper, a lawyer with multiple sclerosis, suffers from life-threatening seizures. For her, morphine is the only drug that has stopped them. But such treatment is unorthodox, so Cooper can't find an emergency room willing to help alleviate the next attack. "I've been given a death sentence," claims Cooper. "If the doctors let me die, they won't be in trouble, but if they treat me, they'll lose their license."

One problem is that many drug regulators don't know about the latest scientific data on treating pain, says David Joranson, a former regulator and director of a Wisconsin-based think tank on pain and public policy. He travels the country educating state medical boards about the validity of treating chronic pain with heavy doses of narcotics. States like North Carolina have rewritten their policies to support aggressive pain treatment, and Virginia is now clarifying its guidelines. Hurwitz is still pursuing his case; many hope that if he wins, chronic-pain patients will get better help. But if he loses, doctors might grow even more fearful. And Linda Tolen might never get another chance to reclaim her life.

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