State Change Could Help Patients Get Pain Medications
http://wlrn.org/post/state-change-could-help-patients-get-pain-medications
Read this article very carefully… the BOP has stated that they have done EVERYTHING WITHIN THEIR AUTHORITY to help chronic pain pts get their medication… Of course, those registrants of the DEA (wholesaler, prescriber, pharmacy) the BOP has no authority over those entities in the regards of this issue… AND.. the DEA and AG Bondi are MIA in changing the path of this denial of care to chronic pain pts. Yes you can TRY and get the Pharmacist’s mindset to stop first start looking for a reason to “JUST SAY NO”. Walgreens has some 20 K Pharmacists and it is my understanding that all it takes is ONE PHARMACIST to “black ball” a pt from all of Walgreen’s 8500 pharmacies. I can almost guarantee that putting all those 20 K Pharmacists thru a re-education program.. will not change 100% of their mindset toward first looking for a reason to fill a controlled Rx. As long as the DEA is out there with tangible or intangible threats of fining corporate pharmacies or wholesalers… the problems from that part of the medication distribution system will be in a holding pattern. Remember… THREE WHOLESALERS controls abt 90% of the market. Pharmacists cannot dispense medication that the wholesalers refuse to sell them because of rationing.
Reacting to pleas from desperate patients unable to get pain medications, the Florida Board of Pharmacy on Wednesday approved a rule change aimed at training pharmacists to change their mindset about prescriptions for controlled substances.
The change switches the rule from a focus on reasons to reject prescriptions for highly addictive narcotics to an emphasis on ensuring that legitimate patients get the medications doctors have ordered.
“Instead of starting out with trying to find a reason to doubt a prescription, you start off with an assumption that everything in the prescription is good, and you work towards achieving patient access,” Florida Pharmacy Association Executive Vice President Michael Jackson said after the unanimous vote Wednesday morning.
The board’s action came after a series of meetings on the issue earlier this year in which members of the Controlled Substance Standards Committee heard from patients, doctors and even pharmacists frustrated by the “pharmacy crawl,” where patients have traveled to up to a dozen drug stores in search of their medications. The problem has escalated statewide in the aftermath of state and federal crackdowns on “pill mills” that earned Florida a reputation as the epicenter of a prescription drug-abuse epidemic.
At least one doctor told the committee about patients with chronic pain who had committed suicide after they were unable to get prescriptions filled. Other patients complained that pharmacists had refused to fill prescriptions because they could not prove that doctors’ orders were “medically necessary.” Some pharmacists complained that distributors had cut back on their supplies of narcotics out of fear of scrutiny from the U.S. Drug Enforcement Administration, which has imposed heavy fines on pharmacy chains and suppliers in Florida.
“I know this is emotional,” Gavin Meshad, chairman of the committee and a member of the pharmacy board who represents consumers. “People are passionate about this. I think we’re doing everything in our power to try to address the problem.”
The rule begins with an affirmation that “it is important for the patients of the state of Florida to be able to fill valid prescriptions for controlled substances” and spells out for pharmacists the necessary steps to ensure that the prescriptions are legitimate and that patients should have them.
The rule also includes requiring pharmacists to take a two-hour, “Validation of Prescriptions for Controlled Substances” course to educate pharmacists about ensuring access to pain medications for “all patients with a valid prescription.” Pharmacists would have until 2017 to take the course.
While the regulatory change won’t have any impact on the amount of drugs pharmacies are able to order from suppliers, the education requirement should help alleviate the difficulty patients are now encountering, said Board of Pharmacy Chairwoman Michele Weizer.
“If (the prescription) is a legitimate purpose and we can get in touch with the prescriber if we need to, they should find it much easier than they have in the past,” she said.
The change, which still needs to go through what can be a time-consuming regulatory approval process, also won’t force chain pharmacies like Walgreens and CVS to revamp corporate policies that result in some patients being blacklisted or turned down even when prescriptions are valid.
But patients can take some steps to improve chances of getting their prescriptions filled, said Jackson, whose association represents independent pharmacies.
Jackson said patients should try to find pharmacies close to their residences or workplaces and establish relationships with pharmacists. Patients should also be “open about sharing their health information” with their pharmacists, Jackson said.
“If you establish a pharmacist-patient relationship, just like a physician-patient relationship, you’ll have a health care provider who’s more motivated to work to resolve your problems,” he said. “But screaming and yelling at pharmacists will only create doubt in the pharmacists’ mind that there’s something going on here that they’re not sure they understand.”
Filed under: General Problems
While I don’t doubt the sincerity of Florida’s BOP that they are doing everything in their power to mitigate the effects of one bad policy after another heaped onto a disorderly pile, a pile that the BOP did not create. However, the BOP for all its beadledom within the state of Florida, the BOP is as the forest chipmunk is to the Grizzly Bear when compared to the DEA. The DEA is the agency with the arsenal of weapons, the personnel and the experience at circumventing the Constitutionally guaranteed rights of anyone that they see as prey. I recall a quote attributed to the first leader of the USSR, Vladmir Lenin. Lenin said, ” How great the weight of the State.” He made this statement to a lieutenant who had been torturing a man accused of some act against Lenin’s regime. The lieutenant had been unsuccessful in breaking the man and obtaining a confession. Lenin was imparting some of his “wisdom” to the lieutenant to remind him that while this man had a great deal of inner strength to resist, the lieutenant had the comparably unlimited power and resources of the Soviet State at his disposal. The lieutenant was being gently chided and at the same time instructed to use that “weight” to obtain the confession or to crush this one man who presumed to impede the Soviet Leviathan. Fast forward almost one century and we have a Federal Bureaucracy that operates with a similar mentailty and, as reported in a very recent spate of news reports, seems to think itself as the one to whom the rules do not apply, the one whom operates with total impunity because all those that are of interest to the modern American Cheka are simply criminals that have yet to be arrested. Intimidation and prevarication are their favorite tools. In the name of the almighty State they threaten to rob all that one has by the wholly Unconstitutional edict of civil asset seizure and to steal a citizen’s freedom by seeing that the unfortunate is locked in a cage for decades. Often they make good on these threats. It’s not the brutal narcotraficantes or the street gang thugs that are the only ones who are crushed by the weight of the State. It’s not only those who are truly guilty of actual crimes that have resulted in the physical harm and the death of others that are reminded by the examples of others that have been under the press; the capability and willingness of of America’s own Cheka is to do the same to them. How many prescribers have been unjustly accused of allegedly providing medically unnecessary scripts, pharmacists and their employers filling scripts that it is claimed that they allegedly should have known were bogus and the wholesalers who allegedly should have been questioning the pharmacies about the increased quantities and types of Controlled Substance orders coming in. I’m not debating the assertion that there were some bad actors in all of this. There were, but the overwhelming majority were performing their duty and playing their respective part in the care of flesh and blood human beings with chronic pain issues.
So the DEA is tasked with interdicting the diversion activity in Florida. Rather than doing the difficult leg work of determining who the actual problem children are in this, the plan is to treat everyone as if they are major players in this caper. Imagine going to work and having a couple of suit wearing, sunglasses sporting goons with guns and a State-Issued piece of costume jewelry shaking you down in your practice like a couple of mob gorillas; they threaten to take everything you own and throw you in a cage. They don’t have any legitimate evidence that you’re guilty of a crime; if they did you’d already be in cuffs and on the way to the local detention facility. Just the same, you’re a criminal and you’re being watched. The criminal justice ststem of this country was founded on the premise of innocent until proven guilty. That foundational principle is solely paid only lip service in the 21st century. From that first encounter, you are now scrambling to establish your innocence. Imagine from that point on you come to work every day in fear. That fear impedes your ability to take care of your chronic pain patients, whether you are the prescriber or the dispenser. If you’re the wholesaler, the fear that the shakedown induces, impedes you’re ability to do what you do and that is to make a living and a profit selling the goods that treat disease and gives the pharmacies the goods that they need to treat patients and also make a living. If you sell less of the goods that are part of your core business, your business and your employees have less.
So it is on the weight of the State that the agency that is charged with prosecuting the failed War on Drugs is utilizing as its strategic initiative. Brute force and terror at the end of a gun dispensed by one of the State’s preeminent orders of punitive priesthood is how the issue of public safety is exchanged for the former freedoms that we used to enjoy in this fast failing experiment of freedom.
Oh lest I neglect, the raison d’être for this missive is that because of this lax, lazy, ham handed, strategy that the DEA has utilized in the execution of their questionable duties, there are numerous legitimate chronic pain patients who unduly suffer destabilized pain and withdrawals because their prescriber has been intimidated into either discharging them through no legitimate fault of the patient, or is under treating their pain in order that the brute squad will be drawn away and induced to go after even lower hanging fruit. Then there are the trips to multiple pharmacies to try and get a legitimate order filled only to be turned away because the pharmacy can’t get the needed stock from the wholesaler, who in turn, is trying to fly under the malignant bureaucratic radar. The patient may be turned away because the pharmacist perceives that there is something not in order. That may or may not be and then again the pharmacist isn’t willing to put his freedom, his license and livelihood and possibly of losing much of what he owns on a misgiving; the misgiving may very well be a heightened sense of fear on account of the threats and nothing more. The script would have been filled without question in a gentler, more trusting time when the judgement of the pharmacist was not clouded with anxiety and fear. If the pharmacy is part of a chain and the patient encountered a particularly uptight, borderline paranoid pharmacist who decided to put the patient on a “black list”, the patient will now not be able to fill their chronic pain med scripts at any of the stores in that chain. Corporate policy. The individual pharmacist has no discretion to decide otherwise and still keep their job with that chain. So the DEA not only leans in the individual pharmacist, but they also lean on the chain management and the patient suffers.
So to whom is the DEA accountable one asks? The chief executive of the United States of America is their boss. The agency was created as a result of the Controlled Substance Act of 1970, as I understand history. Congress passed the bill and President Nixon signed it into law. The DEA was created with an intermediary between the signing of the law and the DEA’s creation. So the DEA answers to the President and Congress has the ability to pass laws that would reign in this loose cannon bureaucracy if the President won’t exercise the moral and ethical prerogative to yank the agency’s chain and stop the abuse of the patients and professionals who are the low hanging fruit that the agency goes after; this is to appear to be effective in the mission that they’re tasked with. I’m not blaming the current administration for this malfeasance. This has been the modus operandi in one form or another of the agency for the last four decades. The two branches of government that have the ability to act in a way that will result in the necesssry changes in short order won’t. In fact, the permissions have been increased over time. The other branch, the SCOTUS has sided with the agency’s desire to continually erode our civil liberties in virtually all cases over the years and all in the name of the biggest prevarication enlisted by the State to enlarge the borders of its power at the expense of the people that it presumes to rule over. That prevarication is Public Safety. The State has no interest in giving up what is usurped from us. It’s a usurpation of that which the foundational document of this nation set as a natural component of every human being that the State could neither grant or revoke as if it was a privilege; the State was only charged to protect these natural imbedded qualities known as inalienable or natural rights.
So right now we have a vulnerable class of citizen who suffers from a bonafied disease called chronic pain and the State discriminates against these people in the name of public safety. There may be a law that is interpreted as authorizing this behavior. That does not make the State’s behavior moral or ethical, standards that supersede any “legal” standard. It certainly does not make this kind behavior acceptable because a group of nine individuals, who are charged with weighing newer statutes against the canon of the Constitution, are too guilty of malfeasance and malpractice in the discharge of their duties.
This issue of chronic pain patients in Florida being made to unduly suffer, through no fault of their own, on account of a Federal bureaucracy out of control is just the tip of the iceberg. Most of us are not concerned, because we aren’t affected; that’s how this always begins. I’m paraphrasing here, but I recall Martin Niemöller saying something to the effect, “When they came for the Jews, I did not protest because I was not a Jew. When they came for the Communists, I did not protest because I was not a Communist. When they came for the Lutherans, I did not protest, because I was not a Lutheran. When they came for the Homosexuals, I did not protest because I was not a Homosexual. When they came for the Catholics, I did not protest because I was not a Catholic …When they came for me, there was no one left to protest.”
How many times does this cycle of history have to repeat itself before we intervene and stop the cycle. We have a weak, partially disenfranchised class of people who are demonstrably suffering in many states in this country aside from Florida. Florida happens to be the epicenter. I don’t live in Florida, but I care. I don’t have the DEA or any other bureaucracy interfering with my ability to make a living or obtain the medications that my physician has deemed necessary to treat my various medical issues…yet. That doesn’t mean I’ll sit idly by and do nothing or ignore the suffering of others just because I don’t deal with the same issues or live in the same geography.
I truly appreciate you creating and publishing this blog Pharmacist Steve. I kinda felt like I was the only one in the profession that noticed these injustices as I had yet to meet anyone else in the profession that I had noticed as genuinely caring. I stumbled across your blog a few months ago and by extension., several others. You’re understanding of the issues is of a superior quality and your compassion is unequivocal.
Thank you for your compassion. God bless you.