Coalition Forms to Ease Pain of Cancer : Medicine: Many victims suffer needlessly because of obstacles to effective treatment, a group of health specialists say.

Arguing that the vast majority of cancer patients suffer unnecessarily because doctors and nurses fail to provide adequate pain medication, a group of oncologists, nurses, anesthesiologists and other specialists met Saturday in San Francisco to initiate a statewide pain-control lobby.

Modeled after a movement begun at the University of Wisconsin in 1986, the California Cancer Pain Initiative plans to mount a public education campaign, urging more patient awareness of effective pain treatments and better education programs in medical and nursing schools. It also will attempt to halt efforts by lawmakers and drug enforcement officials to stem the nation’s illegal drug trade by tightening prescription drug policies.

Although it is one of nearly two dozen organizations of its kind in various stages of development around the country, the California group is encountering powerful opposition from state and federal lawmakers.

One criticism is that the new lobbying groups are being financed by grants from pharmaceutical companies that allegedly want to use doctors and nurses as “fronts” to push their products. The California Cancer Pain Initiative has acknowledged that it received a $10,000 grant for start-up costs from the Upjohn Co.

Over the last four years, scientists throughout the country have received funding from the Bristol-Myers Squibb Co., which gives annual awards to the top scientists and research physicians in the field of pain.

“It’s a sad commentary, but true,” said Pamela J. Haylock, an oncology nurse from Woodside and an organizer of the California Cancer Pain Initiative. “The only money we can get is from drug companies. Universities are doing nothing, the federal government is doing almost nothing about pain.”

Among the critics of the cancer pain coalition is Rep. Pete Stark (D-Oakland) who has become an outspoken opponent of lax drug laws. Stark said he plans to introduce legislation that would establish a national computer bank to record prescriptions written for all controlled substances, including morphine, sleeping pills, tranquilizers and mild cough syrups with codeine.

Under Stark’s plan, records would be kept of every prescription a doctor writes and every prescription filled for a patient. Stark said his proposed system also would help drug agents and prosectors identify patterns of drug abuse. According to the Drug Enforcement Administration, illegal trafficking of prescription medications has become a $25-billion-a-year industry.

This is one of many legislative moves the Cancer Pain Initiatives have opposed. The groups are being joined by the American Medical Assn., which has warned of potential privacy issues that could arise if a national computer prescription bank is established.

Even with strenuous privacy safeguards in place, “I’m not at all certain I’d like anyone to know every prescription that was written for me,” said Dr. M. Roy Schwarz, the AMA’s senior vice president for medical education and science.

The AMA and the nationwide pain awareness coalitions also oppose Stark’s plan because, they say, it would duplicate the Drug Utilization Review Act passed by Congress last year. Under that law, which will go into effect Jan. 1, states must collect data on every physician under their jurisdiction to determine prescribing patterns.

The names of doctors who appear to be diverting drugs illegally would be turned over to law enforcement officials. Those who appear to be ignorant of the best drug therapies would be reported to state medical boards for continuing education.

While the regulations may have some beneficial effect, many state and federal drug laws would “inhibit doctors and nurses from providing patients with adequate pain treatment,” said June L. Dahl, a professor of pharmacology at the University of Wisconsin and one of the originators of the pain initiative movement.

In California, the new coalition has attracted major figures in the field of medicine and law. Among the two dozen professionals listed as members of the steering committee are Dr. Alexandra Levine, chief of the division of hematology at USC Norris Comprehensive Cancer Center and a leading AIDS researcher; Betty Ferrell, a research scientist in the field of pain at City of Hope in Duarte; Corrine Manetto, coordinator of psychological services at Cedars-Sinai Comprehensive Cancer Center, and Dr. Deane L. Wolcott, director of the center’s psychosocial services, and William Marcus, deputy attorney general of the state Department of Justice.

One concern that many pain and cancer specialists have in California is a law requiring doctors who prescribe narcotics and other controlled substances to use so-called triplicate prescription forms. These forms have to be kept on file in doctors’ offices, pharmacies and medical regulatory agencies, where they can be used for drug investigations.

Such a system is in operation in 10 states, and the General Accounting Office is studying what impact those programs have actually had on prescribing practices and patient care. But pain experts involved with the Cancer Pain Initiatives argue they have had an adverse impact.

They cite a recent study published by a University of Wisconsin researcher showing that states with triplicate requirements have had a 50% drop in the use of narcotic pain medications.

Even though the system has been in place in California since 1940, only one in five doctors here has applied for triplicate prescription pads, the Wisconsin study found. That means the vast majority of the state’s doctors cannot prescribe strong painkillers.

“In the area of pain control, education is one of the most serious problems we must address,” said Haylock, an organizer of the California Cancer Pain Initiative.

More than half a dozen surveys over the last 15 years have shown that the majority of medical personnel--doctors, nurses, medical students--are reluctant to give painkillers or to give them in adequate doses, for fear that patients will become hooked. Yet a widely cited study published more than a decade ago in the New England Journal of Medicine found that only four of 11,882 hospital patients who had no history of addiction became hooked on narcotics during treatment--a risk of about three-hundredths of 1%.

Surveys have shown that there are no courses on pain control in most medical and nursing schools. And the federal government has as yet to issue uniform standards for the treatment of cancer pain, even though the World Health Organization has said that cancer pain--not just the disease itself but the pain it causes--is one of the most serious and tragically undertreated health problems in the world today.

World Health Organization surveys have found that as much as 80% of cancer pain goes undertreated, even though pain experts now say that it is possible to reduce or eliminate most physical discomfort associated with cancer and many other diseases.

Even when they know how to control pain, many doctors and nurses have told The Times that they are reluctant to do so for fear of running into trouble with drug agents and medical review boards.

At the urging of pain specialists, a California law drafted by state Sen. Leroy Greene (D-Sacramento) bans disciplinary action against doctors who prescribe narcotics to patients suffering chronic or intractable pain when all other treatments have failed.

“That law went into effect a year ago and yet you go around the state and almost no one has even heard ot it,” Haylock said. “That’s one of the things (the state’s new Cancer Pain Initiative) will have to do.” Although narcotics taken alone or given in combination with other drugs are among the most powerful of all painkillers, pain experts today rely on a variety of techniques to reduce physical suffering, including hypnosis and physical therapy.

The Wisconsin Cancer Pain Initiative--the forerunner of the state’s new coalition--was formed as a reaction against legislation introduced in Congress in 1984 that would have made heroin available to treat pain in terminally ill cancer patients. At the time, many highly regarded pain experts argued that the use of heroin was unnecessary when available and equally effective opiod analgesics were being grossly underutilized.