Modesto man with severe chronic pain can’t get prescriptions filled

http://www.modbee.com/news/local/article20907534.html

Miguel Perez, who has severe multiple sclerosis, lives with an unbearable pain few people ever experience.

The 42-year-old Modesto man is prescribed four pain medications for trigeminal neuralgia, a rare condition causing such searing facial pain it is sometimes called the suicide disease.

In recent months, Perez has been able to fill only one prescription for painkillers because of restrictions on hydrocodone products that went into effect in October. In addition, pharmacies are more careful about filling prescriptions for multiple pain medications because of the epidemic of painkiller misuse.

Perez, who is homebound and severely disabled, is given various combinations of dilauded, Norco, oxycodone and methadone, the latter to lengthen the effect of the pain treatment, his mother said.

The Drug Enforcement Administration reclassified hydrocodone products, such as Norco or Vicodin, as Schedule II drugs under federal law to reduce addiction and fatal overdoses.

Patients are no longer allowed refills for hydrocodone drugs but need a new prescription each time.

Doctors cannot fax or call in prescriptions to pharmacies. Some people with prescriptions for the painkillers said pharmacies ran out of supplies late last year as manufacturers repackaged the reclassified pills with appropriate labels.

Terri Perez, who is Miguel Perez’s mother and caregiver, said pharmacists who dispensed her son’s medications before only refilled the oxycodone last month.

“The pain is horrendous to the point he wants to die,” she said. “I understand there are a lot of people who misuse these drugs, but they should not take them away from people who really need them.”

The DEA says the restrictions are warranted by the scourge of fatal overdoses and widespread addiction to prescription painkillers. Consumer groups have criticized the new rules for hydrocodone, and the pharmacy industry is calling for various players in health care to be involved with addressing misuse of pain medications while ensuring access for patients with medical need.

Terri Perez said pharmacists have sent faxes to her son’s primary care doctor saying they won’t fill the prescriptions due to poor pain management.

Dr. Priti Modi, his primary care doctor, said Perez and some other patients with a legitimate need for pain medications have run into roadblocks. She said pharmacies are not interested in seeing the patient’s medical history.

“The pharmacies are taking over as physicians,” Modi said. “This guy is in so much pain, I don’t know what to do.”

Miguel Perez underwent procedures at Stanford Hospital and University of California, San Francisco, to treat trigeminal neuralgia without drugs, including a radiation treatment and a surgery to deaden the nerve. But nothing has prevented the excruciating attacks. A pain management doctor in Modesto gives him a nerve block that provides a little relief, Terri Perez said.

Modi said her patient needs a fast-acting painkiller to help him bear the attacks of burning and stabbing pain from the trigeminal nerve in his head. The other strong drugs are needed to manage his pain.

Terri Perez said she was denied medication for her son six to eight times at different drugstores, some of them saying they simply were not comfortable dispensing the narcotic drugs. Tuesday, she planned to see if a pharmacy in Turlock would fill the prescriptions.

Besides the DEA restrictions, Perez believes the arrests in January of four people suspected of running a prescription drug ring in Modesto has put a chill into local pharmacists. The defendants are charged with stealing prescription pads from a pain management clinic, having forged prescriptions filled at a CVS Pharmacy and then selling the addictive painkillers on the streets.

CVS spokesman Michael DeAngelis said prescriptions for multiple painkillers will raise a red flag with pharmacists, especially if written by more than one physician. He said changing hydrocodone from a Schedule III to Schedule II drug does restrict access for patients because they are no longer eligible for refills.

The spokesman doubted the recent arrests are making Modesto-area pharmacists extra careful. Rather, pharmacists have a legal obligation to ensure prescription drugs are dispensed for legitimate medical needs.

“We certainly recognize the issue of ensuring legitimate patient access, while preventing prescription drug abuse, and it is something our pharmacists are dealing with every day,” DeAngelis said.

Jose Carranza, who owns independent drugstores in Modesto and Hughson, said pharmacies are now required to place separate orders for hydrocodone products with suppliers and report prescription sales, including the names of patients and doctors, to the DEA.

Physicians cannot fax or call in prescriptions but can use a DEA-approved electronic system for sending prescriptions to pharmacies, he said. “The wholesalers restrict the amount we can buy based on our purchase history,” Carranza added.

He said patients who use the same pharmacy on a regular basis should have easier access because the pharmacist knows the patient and the prescribing physician. The pharmacist said he’s reluctant to tell callers if he has painkillers in stock for fear of theft or burglaries.

DEA spokesman Rusty Payne said the agency supported stricter controls on hydrocodone for more than 20 years and finally received Food and Drug Administration concurrence. He said the DEA does not track individual prescriptions. The restrictions shouldn’t stop a person with a legitimate medical need from getting their medication, he said.

Payne noted the rules permit a doctor to write three prescriptions for 30-day supplies of hydrocodone, thus giving the patient a 90-day supply.

“We are not hiding in the bushes and monitoring individual prescriptions,” Payne said. “We look at bigger picture things like sales by wholesalers.”

A pharmacy trade association is endorsing federal legislation that would require health-care stakeholders and the FDA and DEA to work together to ensure legitimate access to painkillers while preventing abuse.

Walgreens released a statement this week suggesting that more parties need to be involved with formulating regulations for painkillers.

“We firmly believe that addressing prescription drug abuse will require all parties – including leaders in the community, physicians, distributors and regulators – to play a role in finding solutions to combating abuse while balancing patient access to critical care,” Walgreens said.

Perez said the Turlock pharmacy indicated Tuesday it did not have the medications needed by her son.

Filed under: General Problems