Ethan Nadelmann, executive director of the Drug Policy Alliance, which supports legalizing marijuana for medical use, said Bush's new initiative will have a chilling effect on doctors. ``The principal impact of this campaign when you step up the law enforcement response is that doctors will err on the side of undertreating pain,'' Nadelmann said.

The Drug Enforcement Administration and Justice Department have become more aggressive in targeting and prosecuting doctors and pharmacists who they say are improperly prescribing and distributing prescription narcotics, and dozens of health practitioners have been charged in recent years in connection with their prescribing practices. Several are in prison.

Pain doctors and some advocates for patients with chronic pain say the government has become overzealous and has created a "chilling effect" that keeps many doctors from prescribing painkillers that patients need. They argue that the more pressing problem regarding painkillers is that so many patients in pain are not getting them.

"Doctors who prescribe opioids for pain are becoming increasingly intimidated by the government's targeting of legitimate medicine," said Siobhan Reynolds, an advocate with the Pain Relief Network. "We implore our elected representatives to put the needs of ill Americans ahead of the reckless demands of misguided and self-serving government bureaucracies."

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