Pharmacist dismisses patients by order of DEA

http://www.pharmaciststeve.com/?p=11232

The accident happened 10 years ago when Chris Young was 35. He owned a salvage yard in Maui, Hawaii, and his employee had hoisted a junker on a machine called an excavator when the hydraulics gave out. The car fell on him from above his head, smashing his spine…  To control the pain, Young, who has since moved to Florida, needs high doses of narcotic painkillers, but he can’t always fill his doctor’s prescription…

Young’s pharmacist is Bill Napier, who owns the small, independent Panama Pharmacy in Jacksonville. Napier says he can’t serve customers who legitimately need painkillers because the wholesalers who supply his store will no longer distribute the amount of medications he needs. “I turn away sometimes 20 people a day,” says Napier.

Last year Napier says federal Drug Enforcement Administration agents visited him to discuss the narcotics he dispensed. “They showed me a number, and they said that if I wasn’t closer to the state average, they would come back. So I got pretty close to the state average,” Napier says. He says he made the adjustment “based on no science, but knowing where the number needed to be. We had to dismiss some patients in order to get to that number.”

According to Napier, DEA agents took all of his opioid prescriptions and held on to them for seven months. Napier hired a lawyer and paid for criminal background checks on his patients taking narcotics to help him decide which ones to drop…

“What we’ve seen is dramatic reductions in our ability to provide appropriate care for our patients in pain,” says Dr. R. Sean Morrison, director of the palliative care program at Mount Sinai Hospital in New York. Morrison’s patient Ora Chaikin has been taking high levels of narcotics for years to control her pain. She has had multiple surgeries because her bones and ligaments disintegrate, a problem caused by rheumatoid arthritis and other autoimmune diseases. But Chaikin, who lives in Riverdale, N.Y., says her mail order pharmacy, CVS/caremark, has been denying her medications.

“Every month there’s a reason they won’t give me my medication,” says Chaikin. “Sometimes it’s ‘Well, why are you taking this dose?’ ‘My doctor prescribed it.’ ‘Well, why did your doctor prescribe so much?’ ‘Ask my doctor,’” she recounts. “That’s the dose that works for me and you’re made to feel like a drug addict.” …

In a statement, CVS/caremark said that the dosage of pain medication prescribed to Chaikin “exceeded the recommended manufacturer dosing.” It also said that she “continued to receive her controlled substance prescriptions from CVS/caremark without interruption.” …

Ora Chaikin’s wife, Roseanne Leipzig, who is a geriatrician and palliative care physician, says when it comes to narcotics, there is nothing in medical literature that says a dose is too high. “There is no maximum dose for narcotics,” she says. “It’s the dose you need to take care of the pain.”

The Florida Board of Pharmacy, which is responsible for licensing pharmacists and educating them on safe practice, has heard enough complaints from pain patients that it is addressing the issue in public meetings. In June, Lesley Young testified before the board on behalf of her husband. She said she has driven more than 100 miles trying to find a pharmacy that would fill her husband’s prescriptions for painkillers.

“I’ve had to do the pharmacy crawl like many of us here,” Lesley told the board. “I’ve been the one who had to go in and beg, crying, with stacks of his medical records, with stacks of imaging, only to get turned away, often rudely, saying ‘We don’t deal with those kinds of patients.’

The next Florida Board of Pharmacy hearing is set for Monday. A representative of the DEA has been invited to attend.

Because Florida is pretty much the only state where the media is reporting on the war against pain patients, you might think that it’s not happening in other states. Of course that’s not true. And the media is focusing on the pharmacy crawl, which is only one problem among many. I know that doctors are abandoning patients, or just refusing to treat pain patients, but the media isn’t looking at that problem.

Under comments:

lservies, on August 5, 2015 at 6:45 pm said:
In the State of Tennessee, the DEA has forced all state licensed pain clinics to reduce ALL patients meds to under 200 milliequivalents of morphine per day. For us long-time chronic pain patients who are opiod tolerant, that is next to nothing. The State law actually reads that all patients who require more than 200 milliequivalents of morphine doses per day are required to go to a state licensed pain clinic. And now, they won’t let the clinics dispense over that amount.

8 thoughts on “Pharmacist dismisses patients by order of DEA

  1. I have many patients who are terminally ill and in REAL pain who are being forced to self medicate with alcohol and illegal drugs and that scares me as a Nurse because they are at risk relying on themselves to relieve their pain….the war on drugs has shifted from illegal drugs to legal drugs with the uneducated DEA agents overriding Medical Doctors!

    Liked by 4 people

  2. It’s outrageous that the DEA is butting in, at all. But, I live on the outskirts of a town of 5,000 that has a HUGE drug problem. Pill mills agogo. I still see my doctor near Galveston every few months when I visit family, but in town like this, I can almost…ALMOST…understand the DEA’s involvement. Back in the Galveston area, pharmacies refuse scripts from certain doctors that they know are crooked, or from people who they know doctor shop. If they can keep track of the pill docs down there, I don’t know why nobody can keep track of the ones here, in this tiny town, and stop filling scripts for them. In the end, like yesterday, people like me have to wait for a whole day, sometimes longer, to get our prescriptions filled because the junkies have raided the fridge, so to speak. It totally infuriates me. i cannot imagine how angry AND hurt I’d be were I a cancer patient of something of that sort.

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    • You’re blaming the drug addicts and doctor shoppers, when it’s the DEA that controls and restricts the supply. And there’s no way that the DEA can determine which patients are legitimate and which are scammers, so the DEA just guesses as to the needed supply for legitimate patients.

      Unfortunately for pain patients, the DEA gets to decide which patients are “legitimate.” And the DEA doesn’t believe that those who suffer from addiction are legitimate patients. Now, they also don’t believe that chronic pain patients are legitimate patients, and a good portion of the medical industry agrees with them. And if you’re not a legitimate patient, you don’t deserve opioids.

      The DEA has shut down about 250 “pill mills” in Florida, and has shut down doctors and pharmacies all over the country. PDMP use has grown. How many patients and doctors are left who can still scam the system? Nah, drug addicts and doctor shoppers are not to blame. The blame falls squarely on the shoulders of the drug war and the DEA.

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        • You are not only criminalizing the medical conditions these patients suffer from, you are also judging these folks and deciding they’re undeserving of access to certain treatment options. Kinda like how the DEA has decided chronic pain patients are undeserving of long-term treatment with opioids…

          Say, do you work for the DEA?

          Seems to me that doctors should decide who’s suffering from mental illness. And suffering from drug addiction should not be considered criminal behavior.

          Just think if the DEA were to add stimulants like caffeine to the drug scheduling list. People would have to pay a doctor to get access to coffee. Doctors would become even richer than they are now. Of course, no coffee prescription for anyone on welfare or disability — poor people don’t deserve it.

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        • I AM one of those patients. And, I have gone to a pill doc in a pinch. Have you ever gone to one? You should. You’d know exactly what I’m talking about. These are the people that created the atmosphere that gave the DEA entre into MY medical care and I don’t like it. And I don’t care if you want to assume this and that about me all day, this is another time that we’ll have to agree to disagree.

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        • Oh…and asking if I work for the DEA…priceless! Get in your car and drive to a parking lot of a pill mill. I challenge you to do that and not have an opinion about it.

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  3. I couldn’t agree more! No amount of regulations, laws, or bureaucracy can eliminate or control the black market or prevent addiction. Instead the war on drugs has and will likely tragically continue to force legitimate patients to the black market and possibly towards more dangerous drugs such as heroin for pain relief, which will inevitably create even more addiction and risk of overdose. That is the best case scenario for those who live with severe, chronic, and intractable pain whose basic medical care and needs are no longer being met with no accessible alternative. If they are not willing to take such risks out of desperation and survival instinct and their bodies manage to prove resilient enough to avoid a heart attack, stroke, or other fatal consequences of untreated pain, I suppose the most likely next step for the victims will be suicide.

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