Just the specter of law enforcement meddling in medicine has been enough to cause physicians to drop needy patients, says Michael Brennan, a pain management doctor who manages a private pain clinic in Fairfield, Conn., a wealthy town only a few miles from where Hall was charged.

"Doctors are like prairie dogs," he says. "One or two will stick their heads up, but as soon as something bad happens to them, they all go underground."

The American Medical Association stresses that there's no data showing a major shift in prescribing practices or referrals. And says Dr. Herman Abromowitz, a member of the AMA's board of trustees, "The AMA is trying to reassure doctors that if they're doing the right thing -- if they're prescribing appropriately -- they shouldn't have anything to fear."

But Brennan argues that the increased presence of law enforcement is hard to dismiss. In fact, he says that he's still reeling from an unexpected visit by the DEA around Thanksgiving. Though he's strict about whom he'll write prescriptions for -- he regularly meets with family members to ensure that abuse isn't occurring -- he says that "every time I see a big blue Suburban come by my office, I'm like 'Oh man, I hope they're not coming for me.'"

Many doctors looking for creative ways to deal with new layers of regulations have found loopholes that can result in further suffering for the patients they are willing to keep. Many physicians, for instance, are continuing to prescribe pain medication, but are cutting dosages. For sufferers of chronic pain, who often require increased dosages over time because of increased tolerance to their medications, this is a move that promises less relief in the face of increasing pain.

Dabrowski, for one, says she's suffering unnecessarily because of this practice. Dale Denton of Franklinton, La., says it has been disastrous for his 79-year-old father, who suffers from an advanced form of melanoma. Four months ago, his father's doctor cut his father's daily medication intake in half -- from two 40-mg tablets of OxyContin to two 20-mg pills. "Then [the doctor] cut him down to morphine, which is making him sick," says Denton, whose father is on Medicaid. "He told her about it but she wouldn't give him enough. She said there's too many dopeheads. I said, 'They're not going to get it,' and she said, 'Damn right, because I'm not giving it to him.'"

In fact, most users of OxyContin and other strong pain medications are not addicts, says Carr at Tufts University. "For every one case of a robbed pharmacy to get an opioid, there are probably 100 people who are undertreated or appropriately treated."

But, adds David Joranson, director of the pain and policy studies group at the University of Wisconsin Medical School, "America is a country where the treatment of pain is governed by how we perceive the drug-abuse problem." As a result, he adds, "there's a multiplier effect." Laws aimed at the minority are having an enormous effect on the majority, most of whom feel they can barely survive without their pills.

Denton is angry that his father is suffering from unnecessary pain, but he is even more furious that his father's suffering is making the end of his life intolerable. "When he was on Oxy, he could he enjoy his life a little," Denton says. "He was comfortable; he was able to go in the yard a bit. But since they took him off, he's been down in bed and he ain't been back up."

Doctors in many areas also are shuffling pain patients off their rosters. Rather than deal with the increased scrutiny, they're referring patients to pain specialists, many of whom are already overwhelmed. Michael Brennan is dealing with the issue first-hand. About 90 percent of his practice's 800 patients suffer from non-cancer chronic pain and Brennan says that he's in danger of burning out -- in large part because he's receiving a substantial uptick in referrals.

"We have little old ladies on 10 milligrams of OxyContin referred to us because their doctor doesn't want to prescribe it," Brennan says. "People aren't willing to take the risk for their patients. Some will put their patients on non-narcotic pain relievers -- which puts patients at risk -- and others ultimately just say, 'Hey, let's send them to the pain doctor.'"

John Schoos, 45, is a retired banker who used to fill his prescription for the opioid Levo-Dromoran at the CVS near his home in Hawthorne, N.Y. Now, to calm the constant pain resulting from nerve damage suffered during treatment of testicular cancer and hip surgery, Schoos has to go to Memorial Sloane Kettering Hospital in Manhattan, an hour's drive away. And even there, he says, there's strong prejudice against pain medication.

"One of my family friends is a doctor at Memorial, a surgeon," he says. "He knows that I've been on this drug for a long time so one night, he asks me at a party, 'Hey, are you off the pills yet?'"

"And I was like, Jesus, if he doesn't get it, the fact that I need these pills to get up in the morning, imagine how many others don't understand."

Once patients get their drugs, they are frequently limited to a maximum of one month's supply. That means they run out faster, and then, because pharmacies can no longer carry large supplies, they struggle to find a pharmacy to refill their prescriptions. A further limitation, which is another direct result of the painkiller crackdown, is that many patients are being forced by their doctors to sign contracts in which they promise never to visit another doctor or pharmacy for prescriptions. So, if the pharmacy specified in the agreement doesn't have what the patient needs, the patient has to decide what is worse: to violate a contract by going to another pharmacy? Or to forgo medication that makes life livable?

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