“There are millions of chronic pain patients suffering just like me," Danny Elliott wrote before ending his life. "Nobody cares."
DEA, FDA, CDC often overstep their missions. This is all to common a problem.
Many physicians should push back and be aggressive if confronted by their state medical boards, or other regulatory bodies. Organized medicine must do more to protect patient rights to access treatment. A referral to a pain specialist may not be adequate protection. One would think an ethical and properly trained pain medicine physician would escape algorithm care. Then again there are other means to alleviate pain. Suicide should not be an option.
It was a Tuesday in early November when federal agents from the Drug Enforcement Administration paid a visit to the office of Dr. David Bockoff, a chronic pain specialist in Beverly Hills. It wasn’t a Hollywood-style raid—there were no shots fired or flash-bang grenades deployed—but the agents left behind a slip of paper that, according to those close to the doctor’s patients, had consequences just as deadly as any shootout.
On Nov. 1, the DEA suspended Bockoff’s ability to prescribe controlled substances, including powerful opioids such as fentanyl. While illicit fentanyl smuggled across the border by Mexican cartels has fueled a record surge in overdoses in recent years, doctors still use the pharmaceutical version during surgeries and for soothing the most severe types of pain. But amid efforts to shut down so-called “pill mills” and other illegal operations, advocates for pain patients say the DEA has gone too far, overcorrecting to the point that people with legitimate needs are blocked from obtaining the medication they need to live without suffering.
Starting around 2016, a backlash to prescribing opioids began to spread across the U.S. healthcare system, sparked in part by guidance from the Centers for Disease Control and Prevention (CDC) that prompted scrutiny of patients on doses equivalent to over 90 milligrams of morphine per day. The National Committee for Quality Assurance, which develops quality metrics for the healthcare industry, has implemented its own 90 milligram threshold, and patients over that baseline count as receiving “poor care,” regardless of their dose history. In practice that means doctors have strong incentives to reduce the dosage, even for someone like Elliott, who had been taking the same prescription for years, and even if it’s not necessarily in the best interests of the patient. Since 2018, the CDC has developed an initiative called the Opioid Rapid Response Program, which is supposed to assist when doctors lose the ability to prescribe pain medication. Stephanie Rubel, a health scientist in CDC’s Injury Center who leads the program, said when the DEA visited Bockoff’s office, “a healthcare professional was onsite in case any patients arrived for their appointments.”
One of Bockoff’s patients who relied on fentanyl was Danny Elliott, a 61-year-old native of Warner Robins, Georgia.
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