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November 27, 2000

David T. Hannan, M.D.
Chair, AMA Reference Committee B
1202 Driving Park Avenue, Suite B
Newark, NY 14513-1059
FACSIMILE 315-331-4529


Dear Doctor Hannan:

As an American Medical Association (AMA) member and on behalf of Physicians for Compassionate Care, a medical organization founded in Oregon with members in over 40 states, I submit this letter as written testimony in support of reaffirming current AMA endorsement of the Pain Relief Promotion Act (PRPA) and opposing Resolution 214.

The Pain Relief Promotion Act protects doctors and patients by clarifying in federal law for the first time that aggressive pain management is appropriate medical care even if in rare instances it might increase the likelihood of a patient's death. It states that assisted suicide is not an allowed use of federally controlled substances. It promotes improved education and research about pain relief and palliative care. And it provides for grants of $5,000,000 per year for five years. All AMA concerns have been addressed and specific wording introduced to reassure doctors that the PRPA grants no new authority to the DEA and does not shift the existing balance between state and federal authorities in regulating the practice of medicine. AMA support of the PRPA has been repeatedly reaffirmed.

Misleading claims that the PRPA might have a so-called "chilling effect" on prescribing pain medicine are shown to be entirely spurious using empirical data updated this year. DEA data show that per capita prescription of morphine has increased dramatically when states have passed similar laws. Ten states have passed such laws since 1992 followed by an average increase in morphine use of over 50%. Clearly, there is no "chilling effect" here.

As a case in point, in 1992, Minnesota introduced into its existing anti- assisted suicide law wording which is virtually identical to language used in the PRPA. This wording was supported by the state medical society in response to two physicians having been inappropriately investigated after patients died with high levels of morphine in 1990. Those doctors would not have been investigated and would have been protected by the new wording introduced into state law. Minnesota doctors were reassured by this new language; thus, state per capita morphine use rose from 1236 g per 100,000 people in 1992 to 1281 g in 1993, reaching 1816 g in 1994, making Minnesota the 4th highest state in morphine use (data available from DEA). Clearly, there was no "chilling effect" in Minnesota -- quite the opposite. Doctors in the rest of the country deserve to be protected by virtually the same language, language included in the Pain Relief Promotion Act.

The real threat to good pain relief and palliative care is the attempt of one state, Oregon, unilaterally to override existing federal law by legalizing of the use of federally controlled substances for assisted suicide. As a result, depressed patients have been given assisted suicide instead of effective treatment; a demented woman whose psychiatrist found her incompetent and under pressure from her family was given assisted suicide by Kaiser HMO; and Oregon HMOs now fully fund assisted suicide and have capped funds available for hospice care as low as $1,000. These problems and others are documented with full references in testimony to the U.S. House of Representatives Judiciary Subcommittee on the Constitution, June 24, 1999, updated and submitted to the U.S. Senate Judiciary Committee, April 25, 2000. These documents are appended (also see, along with the most current data from the DEA, for the consideration of Reference Committee B.

Physicians for Compassionate Care strongly endorses current AMA support of the PRPA and opposes Resolution 214 or any other attempt to weaken AMA support of the Pain Relief Promotion Act.


N. Gregory Hamilton, MD
President, Physicians for Compassionate Care

enclosures (3)
cc: Dr. Thomas Reardon

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