(8-minute read) BUT PROBLEM IS DEEPER — WHOLESALERS ARE CUTTING SUPPLY
In what has emerged as a crisis within a crisis, patients with chronic pain in Alaska are having a harder time getting legitimate pain medication. They are being turned away by pharmacies for the opioids or other controlled substances that keep their pain manageable.
News accounts across the country report that patients who have had their pain medication cut off or drastically reduced are killing themselves because they can’t live with their chronic pain. Those in chronic pain understand this growing health crisis, which is a personal crisis to them.
[Read: Man, 58, kills himself because pain too much to bear without needed drugs]
This problem grew when recent federal legislation attempted to reduce the amount of illegal opioids hitting the streets through pill mills — unscrupulous doctors who flood the market with classified drugs through misuse of the prescription pad.
But in Alaska, it’s been a painful transition for those who rely on controlled pain medication. Pharmacies have been turning them away, to the point where the patients have reached out to the State Pharmacy Board for relief.
In response to these complaints, a letter went out to Alaska’s pharmacists from the Pharmacy Board last week, telling them to follow the law, which is to fill legitimate prescriptions.
The trend toward “refusal to fill” prompted the board to issue specific guidelines and reminders to pharmacists:
- Pharmacists must use reasonable knowledge, skill, and professional judgment when evaluating whether to fill a prescription. Extreme caution should be used when deciding not to fill a prescription. A patient who suddenly discontinues a chronic medication may experience negative health consequences;
- Part of being a licensed healthcare professional is that you put the patient first. This means that if a pharmacist has any concern regarding a prescription, they should attempt to have a professional conversation with the practitioner to resolve those concerns and not simply refuse the prescription. Being a healthcare professional also means that you use your medication expertise during that dialogue in offering advice on potential alternatives, changes in the prescription strength, directions etc. Simply refusing to fill a prescription without trying to resolve the concern may call into question the knowledge, skill or judgment of the pharmacist and may be deemed unprofessional conduct;
- Controlled substance prescriptions are not a “bartering” mechanism. In other words, a pharmacist should not tell a patient that they have refused to fill a prescription and then explain that if they go to a pain specialist to get the same prescription then they will reconsider filling it. Again, this may call into question the knowledge, skill or judgment of the pharmacist;
- Yes, there is an opioid crisis. However, this should in no way alter our professional approach to treatment of patients in end-of-life or palliative care situations. Again, the fundamentals of using our professional judgment, skill and knowledge of treatments plays an integral role in who we are as professionals. Refusing to fill prescriptions for these patients without a solid medical reason may call into question whether the pharmacist is informed of current professional practice in the treatment of these medical cases.
- If a prescription is refused, there should be sound professional reasons for doing so. Each patient is a unique medical case and should be treated independently as such. Making blanket decisions regarding dispensing of controlled substances may call into question the motivation of the pharmacist and how they are using their knowledge, skill or judgment to best serve the public.
The Pharmacy Board further warned that failing to practice pharmacy using reasonable knowledge, skill, competence, and safety for the public could result in disciplinary actions.
Read: Pharmacy Board Letter to Pharmacies
The State’s Division of Corporations also sent a similar letter, ordering pharmacies to consult physicians before refusing their patient’s opioid prescriptions.
“Recent federal legislation (21 CFR §1306.04(a)) provides more tools to strike this balance; it does not inhibit practitioners’ ability to prescribe controlled substances to patients,” the letter stated
“State law places the treatment of pain in the prescriber’s hands,” said Sara Chambers, director of the Division of Corporations, Business and Professional Licensing. “The prescribing practitioner has full authority to make a diagnosis and determine the appropriate course of treatment, including dosage and quantity of a controlled substance. The patient’s best interests must come first, and pharmacists are valued partners in the healthcare team; however, they are not prescribers and should not refuse to fill a valid prescription without first consulting the prescribing practitioner.”
PHARMACIES CAUGHT IN THE MIDDLE
After the federal legislation to crack down on the opioid epidemic, wholesalers have begun cutting off the supply to pharmacists.
In Alaska and elsewhere, that has meant that if a wholesaler notices an increase in orders, they can refuse to send them. Alaska pharmacies are finding it increasingly hard to even get the drugs being prescribed by doctors.
But that leads to another problem: If a patient is turned away from one pharmacy, he or she will try another. Those pharmacies may not know the patient or feel comfortable with a new prescription showing up out of the blue. In addition, that new opioid prescription increases the number of opioids that pharmacy is filling, and then the pharmacy could find that it has exceeded the percentage of opioids-to-other-prescriptions, and find itself on the black list with the opioid wholesalers.
This has led some pharmacists to refuse to fill an opioid prescription unless the patient brings all of his or her prescriptions to that pharmacy, in order to balance the ratio required by wholesalers.
The burden, then, is shifted downward to the patient.
(Do you have a story about not being able to get your needed pain medication? Send it to [email protected]. Your name and identifiers will be kept confidential)
It is not only the pharmacies that are the problem, doctors are leery of prescribing pain meds now. I had a kidney stone (diagnosed by CAT scan by my doctor) and two weeks later when I was in intense pain I went in to the doctor. I had an appt. a month out to see the urologist and so my general practioner prescribed a six pain pills. Six pills to last me a month. Two weeks later I had severe pain again. Not wanting to go back to the dr and pay 150.00, I called to refill the prescription. Two days of pain (almost went to ER) and they did call in a refill….for four pills. I was still 3 weeks from see the specialist but got in a week later to see him. Could not have the procedure to remove the stones for two weeks so he finally gave me 30 pills. So far I haven’t had to use them but it’s a relief to know I won’t have to be in pain and won’t have to go to the ER. I live in a small town so the options aren’t great for medical…I was ready to fly to ANC if it had been more practical. I realize we have an opiod problem, especially with prescription pain pills, but jeez, just don’t undertreat your patients.
I agree. My husband went to urgent care with an abscessed tooth on the weekend and could not get a single pain pill – with no history of use. Physicians are afraid of the newly enforced consequences for over prescribing – to the point of under prescribing. It was such an embarrassing experience; begging for two pills (thinking he could take one half twice a day until our dental office opened). He was pretty miserable and it got so bad that he needed two courses of antibiotics before the dentist could treat him. We are uninsured, so it was a completely wasted and expensive trip to urgent care.
True Susan. That is part of the issue. The entire system is walking on eggshells. You can lop off an arm and barely get an Rx Tylenol. I suffered a serious medical condition in the not too distant past that required a series of different medications, but even my lifelong GP limited my pain meds. Of course, he doesn’t want to create an addict and I don’t want to become one either. I gobbled Advil until it damn near ate a hole in my stomach. I powered through my issue, but live daily with a certain amount of pain – and that’s ok. There is a certain amount I can live with. But, there has to be a balance. I know people working in the pharmacy business. They know who the dopers and the ‘shoppers’ are…. I’d like to hear from someone in the Pharm industry chime in here and get their take on who they are turning away.
They are just turning everyone away that is not at the CDC recommendations or are on an aggressive taper down regime with their doctor… My doctor called the major pharmacies and spoke with the pharmacists and they said that the letter the state put out means zip to them. they said they will continue with the way they are filling and all that letter means is that they should call the doctor before refusing the script. I spoke to the board of pharmacies yesterday and they are not happy about the way pharmacists are using a “blanket” reason to turn people away and what they are doing is both unethical and illegal. state law places dosages and quantites for controlled substances in the dr hands, yes pharmacists do have the right to refuse to fill the script but they must have a valid reason to do so which the CDC guideline is not. they encouraged me to go to the PDMP website and file a formal complaint so that they can conduct formal investigations and start discipline measures for these pharmacists and pharmacies, she said that if it continues they will start revoking licenses for unethical practices… I plead anyone having a problem at the pharmacy to go to the website and file a complaint as well as call the board of pharmacy, this needs to end, people are already dying because of this problem, if you think we have a Heroin epidemic on our hands now, wait another couple of months when people cannot get meds at all, this whole thing will back fire!
So sorry for what u were put thru, but just to clarify we do not have an opioid “problem” We have a heroin/illicit fentanyl (carfentanil) crisis that is coming into this country daily. The DEA would rather take on the easy targets , what’s left of our pain drs, shut them down, take everything they worked so hard for, The DEA confiscates pain pts medical records , doesn’t give them back. leaving thousands of innocent law abiding pain pts in a torturous hell.
We don’t have a problem with prescription pain pills; 95%of the deaths are from illegal drugs. But since the worthless government fails to enforce it’s prohibition on illicit drugs, it turns the thumbscrews tighter on the legitimate prescriber with more oversight, higher fees and more bureaucracy. And unfortunately you the suffering patient have felt the effects of an overbearing government and should expect to feel even more in the future. We clearly are doomed.
Suzanne, you do the best job of investigating a topic and reporting on it of all news reporters in Alaska. This article highlights many of the issues pharmacists are facing as a result of the opioid problem our country (and state) has gotten itself into. There is more to this story, keep digging.
Yes she does!
Thank you Susan!
Having a none licensed medical doctor practicing medicine via elected and employed bureaucrats practising medicine via regulation and statue exempt from facing medical malpractice is simple a folly.
Think the ones setting regulations on doctors a nd pharmacist with one strike of the pen follow that with funding grants for fresh needle free to addicts and free narcon to revive addicts??????
Dr.s meet and evaluate individuals let them do their job!
If a person who abuses the drug really wants them they will turn to the streets. The opioid problem is in the street fentanyl drugs. Very few overdoses don’t include fentanyl. The world health organization is concerned about how America is solving it’s problem because we are suppose to use these drugs to relieve pain and suffering. For some their chronic pain is not to much different than torture or a hostage. They have PTSD from the fear of more increased pain when they are not functioning well with the pain they have already.
I think making some new guidelines would be helpful like making sure doctors use the lowest dose possible from the beginning. But this making people suffer to the point of suicide needs to stop.
The CDC did not come up with the 2016 Opioid prescribing guidelines. They just printed what their hired consultants (PROP) told them. Andrew Klodney and Jane Ballentyne (members of PROP) had a vested interest in Addiction Centers of America.CDC policy.
In essence, PROP defrauded a Federal Agency, if convicted they could serve years in prison not to mention being held accountable for the pain and suffering including suicides that results from this illegal act.
The CDC and FDA are not speaking to each other.
When you are told about the CDC guidelines at your pain doctor, tell them you want to follow the FDA guidelines. There are not.
In November, the AMA met in Maryland and came up with resolution to end the abuse of the 2016 Opioid prescribing guidelines. There are about 200,000 doctors that are members of the AMA. Let’s hope they got the message.
Thx Timothy for the good information!
I’ve had chronic pain for many many years. I’ve been to all types of Dr.s trying to figure out the problem. As soon as my pain Dr and I find meds that work for me to make me at least comfortable a little, then all the sudden the ak native hospital is telling me this year that opioids does not help my type of pain! They are so scared of giving pain meds, that for people with legitimate pain for years they are all the sudden telling us that it won’t work for our type of pain. I’d like to know how they can look us in the eye,while we are crying,wincing,stressed, from pain and tell us what works for us and what doesn’t. Walk a mile in our shoes the saying goes. But I wouldn’t wish half this pain on my worst enemy!
MY DOCTOR CALLED THE MAJOR PHARMACIES IN THE VALLEY, THEY SAID THEY DON’T CARE ABOUT THOSE LETTERS AND ALL IT SAYS TO THEM IS THAT THEY JUST HAVE TO CALL THE DOCTOR BEFORE THEY REFUSE IT AND THAT THEY ARE NOT GOING TO CHANGE THIER FILLING PRACTICES. I SPOKE WITH THE BOARD OF OHARMACY AND THEY ARE NOT HAPPY HEARING HOW PATIENTS ARE BEING TREATED AND ENCOURAGED ME TO GO ONTO THE PDMP WEBSITE AND FILL OUT THE COMPLAINT FORM SO THEY CAN START A FORMAL INVESTIGATION AND START FORMALLY DISCIPLINING THE PHARMACIES AND THE PHARMACIST FOR THIER ACTIONS, THEY ARE UNPROFESSIONAL AND FRANKLY AGAINST THE LAW, STATE LAW PLACES DOSAGES OF A CONTROLLED SUBSTANCE IN THE PROVIDERS HANDS, YES THE PHARMACIST HAS A RIGHT TO REFUSE THE SCRIPT BUT THEY MUST HAVE A VALID REASON, THEY CANNOT USE A “BLANKET” REASON, THEY MUST TREAT EVRY CASE INDIVIDUALLY BY LAW….
So is the board of pharmacy going to send a letter to prescribers telling them to make themselves more available to pharmacists phone calls?
A script that I have had for chronic pain for over 10 years has all of a sudden needed confirmation from the physician to fill. This is done on a weekend so it will take 2-3 days for me to possibly get filled. I have had my dosage reduced and the pharmacist still wants my doctor to approve a script they already wrote. Let’s think of a few ways the pharmacist is acting outside their scope…
1. Practicing medicine without a medical license
2. If they are going to refuse a script and they have already held it for numerous days they need to provide a reason why, otherwise it is intentional infliction of pain and suffering.
3. If pharmacies/pharmacist are going to be the final word in health care they need to follow HIPAA
4. Pharmacist seem to have lost professional discretion and authority when they cut a medication off on a weekend for no clincal reason. Try going to work when your pain meds that you have been taking for years are suddenly stopped for no reason.
I have probably 10 more violations of pharmacist oaths and licensing violations. I am generally easy going and understand we all have issues to deal with in work. The pharmacists are siding with keeping a job for the temporary with the long term problems they are causing. Unfortunately, a few examples may need to be tested in the public forum with loss of careers and organizational licensing to follow. Using the excuse of having to confer with a doctor in order to hold a prescription sucks. I wish they would just say that they are no longer filling the scripts
Let’s get a lawyer on this with a class action suit and start leveraging pharmacist and pharmacy licenses with what is good for the population.
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