Why is Oregon Special?

Policy on controlled substances must apply
to the entire nation

By Kenneth R. Stevens, Jr.

The legal issue before the U.S. Supreme Court isn't about whether Oregon can permit assisted suicide. It's about whether a state can unilaterally exempt itself from federal regulations. The Controlled Substances Act (CSA) mandates a uniform national policy on prescribing controlled drugs.

For decades, the CSA has forbidden the use of certain addictive and dangerous drugs for any non-medical purpose. The CSA's legislative history identified suicides and drug-related deaths, as well as recreational drug uses, as a misuse of controlled substances.

In November 2001, then U.S. Attorney General John Ashcroft stated that doctors who prescribe these drugs could lose their federal prescription licenses.

Nothing in the directive prevents physicians from assisting suicides. The directive applies only to the use of federally controlled drugs. It has no effect on how states regulate the practice of medicine. Doctors may still prescribe any of thousands of drugs that aren't federally controlled.

In Oregon, it is barbiturates (sleeping pills) and not pain medications that are being prescribed for the purpose of assisted suicide.

Using controlled substances for pain management has long been recognized as a legitimate medical purpose. Appropriate pain management enhances life and protects the terminally ill during their greatest vulnerability. Ashcroft pledged no increased scrutiny of prescriptions to control pain, "even when high doses of painkilling drugs are necessary and even when dosages needed to control pain may increase the risk of death."

The Supreme Court should uphold the need for the government to determine the use of federal prescribing registrations.

Regardless of how that issue is resolved, Oregon's law is wrong. Physicians across the nation can provide superlative care of the seriously ill without resorting to assisted suicide.

No other state has followed Oregon in legalizing this practice. To date, there have been no documented cases of a lethal overdose being prescribed because of untreatable pain. It is always for psychological and social reasons such as fear and depression.

Unfortunately, the Oregon law allows depressed, frightened and confused patients to be given overdoses by a few misguided doctors. We lament this unnecessary loss of life.

Kenneth R. Stevens, M.D., is an oncologist in Portland, Ore., and vice president of Physicians for Compassionate Care Education Foundation.

Published in USA TODAY, October 5, 2005, as an Editorial/Opinion Debate article.