Dynamist Blog

Real Pain

John Tierney has been following the retrial of Dr. William Hurwitz, the pain doctor accused of drug trafficking because some of his patients misused or resold medications he prescribed. Today's column focuses on testimony from one of the government's paid experts, Dr. Robin Hamill-Ruth, whose attitudes and actions illustrate just what's at stake for patients.

Dr. Hamill-Ruth, who noted that she never prescribed the highest-strength OxyContin tablet, said some of Dr. Hurwitz's actions were "illegal and immoral" because he prescribed high doses despite warning signs in patient behavior that the opioids were being resold or misused.

Then, during cross-examination by the defense, Dr. Hamill-Ruth was shown records of a patient who had switched to Dr. Hurwitz after being under her care at the University of Virginia Pain Management Center. This patient, Kathleen Lohrey, an occupational therapist living in Charlottesville, Va., complained of migraine headaches so severe that she stayed in bed most days.

Mrs. Lohrey had frequently gone to emergency rooms and had once been taken in handcuffs to a mental-health facility because she was suicidal. In 2001, after five years of headaches and an assortment of doctors, tests, therapies and medicines, she went to Dr. Hamill-Ruth's clinic and said that the only relief she had ever gotten was by taking Percocet and Vicodin, which contain opioids.

Mrs. Lohrey was informed that the clinic's philosophy "includes avoidance of all opioids in chronic headache management," according to the clinic's record. The clinic offered an injection to anesthetize a nerve in her forehead, but noted that "the patient is not eager to pursue this option." Mrs. Lohrey was referred to a psychologist and given a prescription for BuSpar, a drug to treat anxiety, not pain.

"You gave her BuSpar and told her to come back in two and a half months?" Richard Sauber, Dr. Hurwitz's lawyer, asked Dr. Hamill-Ruth. Dr. Hamill-Ruth replied that unfortunately, the clinic was too short-staffed at that point to see Mrs. Lohrey sooner. Under further questioning Dr. Hamill-Ruth said that she was not aware that BuSpar's side effects included headaches.

As someone who suffers from comparatively mild migraines, treatable with Imitrex (which itself can feel awfully hard to obtain when you're waiting for a pharmacy to verify your prescription while feeling an invisible spike plunged through your eye), I can only imagine how desperate Mrs. Lohrey must have been. Read the whole thing. And check out Jacob Sullum's 1997 Reason feature on the subject, which should have won a National Magazine Award (it was a finalist) but was beaten out by a far less memorable, but more establishment, feature on computers in the schools published by my current employer.

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