Treatment for chronic pain remains one of those medical mysteries. Each of us deals with it differently. One person's minor ache is another's agony. The main relief comes from a variety of drugs that are often abused by addicts and have their own international black market.
As a result, in this country, doctors tend to under-prescribe painkillers because of their addictive nature and for fear of attracting the attention of authorities. Their patients are also often under suspicion when they try to alleviate unrelenting pain — when they become prisoners of pain.
Correspondent Morley Safer reports the story of one man's ordeal.
At the Tomoka Hills maximum security prison just outside of Daytona Beach, Fla., barbed wire and constant surveillance are meant to keep its hard cases from escaping. But there's at least one inmate who poses no such threat.
Richard Paey is in a wheelchair because of a severe spinal injury. Without constant medication he is in excruciating pain. It was pain that put him on the path to prison.
"I felt like my legs were being dipped into a furnace," says Paey. "They were burning, and I couldn't move them. It's an intense pain that, over time, will literally drive you to suicide."
Paey says he tried to kill himself twice. "And for me, death would have been a form of relief."
Pain-killing drugs were his salvation but pain-killing drugs put him behind bars for drug trafficking.
How did this Ivy League-educated lawyer and 47-year-old father of three end up as a convicted drug trafficker?
It began in 1985, when he saw a promising future shattered in a car crash outside Philadelphia. A failed operation left him with metal screws in his spine and unrelenting pain.
To add to his problems, he was later diagnosed with multiple sclerosis. Paey says doctors could do little for him beyond prescribing painkillers, including Percocet, Vicodin and Acetaminophen with codeine. The drugs worked, but only briefly.
"As I got worse, I developed a tolerance also with the medication. And so I needed larger doses. Higher doses," he says.
He says he needed the higher doses to live daily life.
"Yes, to relieve the pain. To be a father. To be a husband. To be a member of the community," he says. "I mean, the choice was to almost lie in bed and be a vegetable."
Paey's wife, Linda, worried about his growing dependence on the drugs.
"We were fearful of addiction. We were always worried," she says. "He was afraid to take too many pills. He would play these mental games to try to decrease them himself."
But without the drugs, Linda says there was no relief.
When the Paeys moved to Florida, getting the drugs was the problem. Paey says doctors were fearful of attracting police attention because of his high doses.
"One was quite frank and said that I was, in a word, he said, 'screwed,' " says Paey. "And I was in that medical nightmare zone where you've gone through all the treatments, and nothing works. And what does work, what does help, no one wants to prescribe because it attracts attention, and no one wants that attention."
What did he do to obtain his medication?
"My doctor in New Jersey, who had been with me for almost seven years, agreed to continue the care," says Paey.
Paey's doctor in New Jersey, Stephen Nurkiewicz, agreed to mail and fax prescriptions to him in Florida. To ensure that Richard would never run out of pills — his worst nightmare — Nurkiewicz left some of the prescriptions undated.
But Paey's frequent refills drew the attention of law enforcement. Florida has seen a dramatic increase in the sale of black market painkillers. Convinced that Paey might have been re-selling the drugs, local police placed him under surveillance. After two months, they made their bust.
"They had guns and ski masks and, like, five, six people ran into the house and half of them took the kids and my mother in law. And the other one grabbed me," says Linda Paey. "And Rich kept on saying, 'Please, call my doctor. Can you call my doctor?' You know? 'Everything's fine. Call my doctor.' And they said they already have."
Indeed they had. The doctor was originally a suspect.
In interviews with the Drug Enforcement Administration, Nurkiewicz at first supported Paey and admitted mailing him undated prescriptions and, when pharmacists called, he verified the prescriptions.
But when he was later shown evidence that Paey had filled 200 prescriptions over a two year period for 18,000 pills, he then stated that all of the prescriptions were forgeries, including some he had originally verified to pharmacists. He was no longer a suspect, instead becoming a witness for the prosecution.
Nurkiewicz would not talk to 60 Minutes.
But state prosecutor Scott Andringa did talk, and while he acknowledges that Nurkiewicz's statements were "inconsistent and contradictory," he also says Richard Paey took advantage of his doctor's inattention to detail.
"In Richard Paey's room, all over his room, there were the raw materials to make prescriptions," says Andringa. "They found a lot of documents that suggested forging prescriptions, copying prescriptions, in order to create new blank prescriptions."
In addition to the blank prescriptions, Andringa says police also found a copy machine, a doctor's stamp and Nurkiewicz's DEA number written in Paey's address book.
"It's a crime to forge prescriptions, which is what he did, and it's a crime to use a forged prescription that you stole in order to get drugs from a pharmacy, which is what he did," Andringa says.
Despite the evidence, Paey continues to deny any wrongdoing. On the accusation of selling, he says he never sold any drugs.
"They put my wife and I, my family, under surveillance for three months," says Paey. "During that three month period, they followed us to church. They followed my wife to work. They interviewed my neighbors. This went on for three months. They found nothing."
But apparently they found 60 bottles of pills in Paey's home.
"They found 60 empty bottles, sir," Paey says.
Paey says he never sold any pills. "No, Mr. Safer, I was in such pain, they were so hard to get. I was a buyer in a sense. I mean, I wasn't a seller."
But Andringa says Paey couldn't possibly have taken all of the pills he obtained — an amount that would require him to consume 25 pills a day.
"One pill every hour, every day, for two years, with assuming he didn't sleep. If he slept for any period of time during that two-year period, he'd have to take more," he says.
Did Andringa assume at the beginning that Paey was selling drugs?
"There was certainly an implication that he was selling drugs," says Andringa.
"You did not present a shred of evidence that he sold a single pill," Safer says.
"Nobody saw him selling," says Andringa. "The evidence suggests it, but it doesn't prove it conclusively. But it is a reasonable inference from the facts that he was selling them, because no person can consume all these pills."
But Paey says he consumed every single pill. 60 Minutes asked Dr. Russell Portnoy, chairman of the Department of Pain Medicine at New York's Beth Israel Hospital if that's possible.
"People are literally able to take industrial strength doses without sustaining any problem at all," says Portnoy. "Look, I take care of two grandmothers. Each one requiring grams a day of morphine. Absolutely extraordinary doses. Now, obviously, if these high doses were given before they had a chance to acclimate to the drug, they would have been lethal."
Does Portnoy think authorities have been overzealous in going after doctors and patients who are abusing the pain medication?
"There's a very deep concern on the part of the medical profession that the authorities don't know anything about pain medicine; and are so afraid of prescription drug abuse that they tend to investigate or go after prescribers on the basis of very weak evidence," says Portnoy.
In the end, while there was no evidence Paey was selling drugs, under Florida law, the possession of just one bottle of illegally obtained painkillers — just 28 grams — is considered drug trafficking, which carries a higher penalty than trafficking in much larger amounts of cocaine.
"The word 'trafficking' in a lot of people's minds outside the law suggests sale," says Andringa. "Trafficking can mean sale, but it can also mean possession of a quantity of a controlled substance over a certain amount."
And Paey easily obtained that amount. Surveillance video shows Paey walking with difficulty, with the aid of leg braces. It also shows him obtaining 1,600 pills over a 41 day period, with eight prescriptions that his doctor said were forged. Paey was facing serious charges.
Andringa's office offered him a plea bargain, which carried no jail time as long as he admitted to the crimes.
But Paey says he feared that would be trading one prison for another.
"There is something worse than living in severe, unrelenting pain. And that's living in severe, unrelenting pain not getting relief," he says. "Had I accepted a plea bargain and carried that, a conviction on my record, I would have found it near impossible to get any medication. I didn't wanna plead guilty to something that I didn't do."
Asked if he is a stubborn guy, Paey says he thought it was a principled position to take. "I was trying to retake that dignity I had lost and this, I felt, the state was so hell-bent on taking from me."
But prosecutor Andringa says that the jury was convinced by the evidence that Paey had forged some prescriptions.
"This case is not about pain patients. It's just not. This case is about prescription fraud," he says. "We were very reasonable in this case. But once somebody says, 'I'm not going to accept a plea offer however reasonable it is,' then …"
"You throw the book," Safer says.
"Exactly. And Mr. Paey knew that. He went to law school," Andringa says.
A jury convicted Richard Paey of 15 counts of prescription forgery, unlawful possession of a controlled substance, and drug trafficking. Under Florida law, the judge had no alternative but to sentence him to 25 years.
Paey admits he expected to win in court.
His wife, Linda, was shattered by the verdict. She says it is just too difficult for her to allow her children to see their father in prison.
"I'm not going to tell the children that their, he's gonna be in for 25 years," says Linda Paey. "I just, I can't do that. You know, I really think he will get out and, as time goes, you know, they grow, he gets grayer. So I don't, I'm the only one who sees that."
Portnoy, among the most eminent pain specialists in the country, says that Paey's behavior — wanting to ensure a steady stream of pain killers — is not unusual among patients in severe pain.
"It really sounds like society used a mallet to try to handle a problem that required a much more subtle approach," says Portnoy. "If they had taken this man who had engaged in behaviors that were unacceptable and treated it as a medical issue, it seems like this patient would have had better pain control and a functional life instead of being in prison."
Ironically, Richard Paey now gets all the drugs he needs. The state of Florida pays for a morphine pump which delivers a constant stream of medication directly to his spine, providing him with pain relief at doses more powerful than the drugs he was taking when he was arrested.
To contact Richard Paey or to learn more about his appeal, contact the Pain Relief Network.
By Deirdre Naphin By Deirdre Naphin
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