<lst>The number of pills prescribed to retired physician Dr. William Fleischaker, who flew from Arizona to McLean to be treated by Hurwitz, were not what he expected.
But the high-dose therapy enabled him endure physical therapy and regain the ability to walk again, he said.
The doses are shocking to a lay person, with some patients taking dozens of powerful OxyContin or other pills in a day, when the normal dose is one every 12 hours for severe pain. But for many legitimate patients with unrelenting, chronic pain, the high-dose pain therapy is the only approach that has provided relief.
High-dose opioid therapy is a science still "struggling with its own protocols," according to Patrick Hallinan, one of Hurwitz's three attorneys. The formula used by doctors to treat chronic pain is based on increasing the dosage of opioids until the patient says the pain is relieved.
Controversy surrounds the practice of high-dose, long-term opioid therapy in the medical community and beyond.
There is no limit to the amount of opioids a person can safely take as long as the dose is gradually increased and monitored, according to Dr. Steven Passik, who testified for the defense.
According to Dr. Michael Ashburn, who testified against Hurwitz, "The notion that you can go to infinity is unreasonable."
The problem with treating chronic pain with opioid therapy revolves around the trust a doctor must have with his or her patient. Any doctor who prescribes opioid pain therapy will be targeted by a small percentage of patients who are seeking drugs to feed an addiction or to sell illegally.
"Pain is so subjective, it's so important to listen to the patient's experience," Passik testified. Following his testimony, Passik said if you don't get duped by drug-seeking patients a small percentage of the time, "you're probably not treating pain aggressively enough."
Although Ashburn agreed that doctors must believe and rely on the subjective report of pain by patients, "to accept them at their word would to a tremendous disservice," he testified. "My obligation is to be very careful on the patient's behalf."
All doctors, who testified in Hurwitz's trial, claim that untreated chronic pain is a serious condition and important health care problem. "Pain is not a benign condition," testified Dr. James Campbell, vice-chair of neurology at Johns Hopkins University. "Untreated pain may do damage to the brain."
<lst>Count 1: Conspiracy to distribute and dispense, or cause to be distributed and dispensed, a controlled substance not for a legitimate medical purpose or beyond the bounds of medical practice
Counts 2-3: Illegal distribution resulting in death
Counts 4-6: Illegal distribution resulting in serious bodily injury
Counts 7-59: Drug trafficking distributions
Count 60: Continuing criminal enterprise
Counts 61-62: Health care fraud