The Addiction Front: DOJ sends letter to physicians, groups working together

http://fox47.com/news/the-addiction-front/the-addiction-front-doj-sends-letter-to-physicians-groups-working-together

Just like a lot of other media articles –

THERE IS NO PLACE FOR COMMENTS FROM THE COMMUNITY

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https://www.kvue.com/article/news/investigations/medical-device-dangers/spinal-cord-stimulator-leaves-local-marine-paralyzed/269-b0ab4177-daa1-47c3-a576-7078217d0be8

From living with back pain for years to a life-changing procedure. Only the change was not at all what he expected.

NEW BRAUNFELS, Texas — David Winnett has seen a lot. He retired from the Marines as a captain after spending 20 years and countless tours around the world.

“I did three tours in Okinawa. I did a tour down in Guantanamo Bay before 9/11,” said Winnett.

The training took its toll.

“I developed degenerative discs. I started developing severe back pain the last two to three years of my career,” he said.

Push to get patients off pain pills

For years, pain pills helped. Then doctors pushed Winnett to consider an alternative – a spinal cord stimulator (SCS).

“They told me I could relieve the back pain and get off the opiates,” he said.

Stimulators use electrical currents to block pain signals before they reach the brain. Each year, 50,000 are implanted worldwide.

He scheduled surgery for September 2017, a one-week trial to see if he should get the permanent implant.

“I came out of recovery and, within about a minute of waking up, I felt a very intense pain in my left groin,” he recalled.

He stood up for what he did not realize would be the last time.

“I laid back down and the exact same thing began happening on the other side – intense pain – and then the pain hit my back. It was like someone was stabbing me in the spine. It was just horrible, I just started screaming,” Winnett said. “Around that same time, my legs went to sleep.”

Doctors flew Winnett to Austin for emergency surgery, removing the stimulator first.

RELATED: 

FDA holds hearings over surgical staplers

Surgical mesh: Defenders shine a light on yet another dangerous medical device

“I thought the pain at the clinic in my groin was bad. Oh, no, this was like a thousand times worse,” he said. “The next day I woke up in ICU. The doctor who put the device in came to visit me and he was apologizing to me and I said, ‘Hey doc, that pain, when they took that thing out, was horrendous.’ And he said, ‘Didn’t they turn it off?’ He looks at me. And I think, why didn’t he turn it off?”

He took a video while recovering in the hospital that showed the lights were still flashing, the power to the stimulator was still on.

“It literally felt like I had sparks inside my spine – it was that bad,” he said. “An MRI taken right after they pulled them out in Austin showed that one of the leads had taken a wrong turn. It hadn’t gone straight in.”

Doctors determined the stimulator hit a blood vessel, causing blood to fill his spinal column killing the nerves of his spine. The life-changing surgery changed him in ways he never imagined.
         

“I’m a paraplegic. This has just been a nightmare.”

Winnett is not alone. Device Events.com found 681 people have been paralyzed by spinal cord stimulators and more than 100,000 other injuries – most since 2008.

Dan Ross, an Austin attorney, represents Winnett and has represented a number of other patients with medical device injuries.

“There are many heartbreaking stories including David’s,” said Ross. “Companies have been successful in getting judges to throw out these cases because they are preempted by a law that doesn’t offer any remedies.”

The device Winnett had implanted was approved a month before his surgery through the pre-market approval (PMA) process, meaning it did undergo some human clinical trials.

People harmed, killed or disabled by a medical device that the U.S. Food and Drug Administration classifies as Class III cannot sue the manufacturer. Class III devices have the highest risk – they include cardiac stents, pacemakers and stimulators.

This is due to a 2008 U.S. Supreme Court ruling. The case Riegel vs. Medtronic granted “pre-emption” protection to makers of devices that undergo PMA. The court ruled that, because the devices undergo clinical trials and studies, they are subject to liability protection.

RELATED: 

Texas congressman to address implanted medical device dangers after KVUE Defenders report

Defenders: How medical devices are approved by the FDA and why some say it no longer works

That means Winnett cannot sue the manufacturer for what happened. It’s a loophole Congressman Lloyd Doggett and others want to fix with the Medical Device Safety Act.

“It’s important that doctors get this information in and that we have the right. Everyone has the right to seek redress for their injuries and that these companies don’t hide behind the FDA,” said Doggett.

Retirement plans altered

It is too late for Winnett.      

“I did not plan to spend my retirement this way,” said Winnett. “Ironically, even after this paraplegia, I still have the same back pain because I’m paralyzed below that level.”

He makes the best of each day sharing his story in hopes of helping others know the risks.

“I tried to do the right thing, what’s politically correct nowadays, to get off the opiates. Well, look what happened to me as a result. If I’d had it to do over, I would have slept in that day,” he said.

Comment from NANS

The North American Neuromodulation Society issued a statement about spinal cord stimulation this fall. It can be found here.

It states that “approximately 60,000 SCS therapies were implanted in the U.S. in 2016. Up to one-third of patients implanted with a SCS system will experience a complication, the vast majority of which are minor. “

It goes on to state, “Reported severe neurologic complications, including paralysis, occur in less than 1%.”

RELATED VIDEO: The dangers behind implanted medical devices

If you have had experiences with medical device dangers, we encourage you to join the Medical Device Dangers Facebook group.

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Large Trial Finds Proton Pump Inhibitors Safe for Longer Term Use

https://www.uspharmacist.com/article/large-trial-finds-proton-pump-inhibitors-safe-for-longer-term-use-1/

Hamilton, Ontario—Despite past reports of serious health issues with proton pump inhibitors (PPIs), pharmacists can offer some reassurance to patients using the drugs to treat gastroesophageal reflux disease or related diseases.

A new study published in Gastroenterology found no evidence that PPI use increases risk for pneumonia, chronic kidney disease, diabetes, or dementia. Results came from a large, multiyear, randomized trial of patients receiving rivaroxaban or aspirin.

McMaster University–led researchers said there is no reason to limit PPI prescriptions because of concerns about long-term harm, although the medication should be used only when the benefits are expected to outweigh the risks and according to recommended dose and duration of treatment.

“Our research provides welcome news for the countless patients who rely on PPIs to control their symptoms, as well as the physicians who prescribe this medication,” said lead author Paul Moayyedi, MB, ChB, PhD, The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. “To our knowledge, this is the first prospective randomized trial to evaluate the many long-term safety concerns related to PPI therapy. It is reassuring that there was no evidence for harm for most of these events.”

Noting that the drugs are effective at treating acid-related disorders, the study team points out that although the drugs have been shown to be well-tolerated in the short term, observational studies have raised questions about long-term treatment. The trial of 17,598 participants with stable cardiovascular disease and peripheral artery disease was designed to answer those concerns.

The study randomly assigned 8,791 patients to 40 mg of pantoprazole daily and 8,807 to placebo. In addition, participants were divided into groups receiving rivaroxaban (2.5 mg twice daily) with aspirin (100 mg once daily); rivaroxaban (5 mg twice daily); or aspirin (100 mg) alone.

Researchers tracked any development of pneumonia, Clostridium difficile infection, other enteric infections, fractures, gastric atrophy, chronic kidney disease, diabetes, chronic obstructive lung disease, dementia, cardiovascular disease, cancer, hospitalizations, and all-cause mortality every 6 months, with follow-up of a median of 3.01 years.

Results indicate no statistically significant difference between the pantoprazole and placebo groups in safety events except for enteric infections (1.4% vs. 1.0% in the placebo group; odds ratio, 1.33; 95% CI, 1.01-1.75).

Study authors point out that, for all other safety outcomes, proportions were similar between groups except for C difficile infection, which was approximately twice as common in the pantoprazole versus the placebo group; only 13 events occurred, however, so the difference was not considered statistically significant.

“In a large placebo-controlled randomized trial, we found that pantoprazole is not associated with any adverse event when used for 3 years, with the possible exception of an increased risk of enteric infections,” researchers conclude.

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Staggering drug bust shows traffickers turning to East Coast

https://www.siouxlandproud.com/news/national/staggering-drug-bust-shows-traffickers-turning-to-east-coast/2086600888

If drug interdiction can be compared to a giant game of whack-a-mole, federal law enforcement officials delivered one mighty wallop this week when they raided a container ship at Philadelphia’s port and discovered a staggering amount of cocaine.

Hidden inside seven shipping containers were 33,000 pounds (15,000 kilograms) of the illicit drug, one of the largest caches ever intercepted on U.S. shores and a quantity that’s almost “beyond comprehension,” as Patrick Trainor, a spokesman for the U.S. Drug Enforcement Agency in Philadelphia, put it Wednesday. Federal officials estimated the seized drugs had a street value of more than $1 billion.

The feds’ find was another sign that traffickers are turning to East Coast seaports as a result of increased law enforcement pressure along the country’s southwest border, a development cited by the drug enforcement agency in its latest national threat assessment. It was at least the third major bust in Philadelphia and New York since February.

“As soon as interdiction puts pressure on one place, it just pops up somewhere else. We’ve continually seen that,” said Nicholas Magliocca, a University of Alabama researcher who studies how traffickers adapt to interdiction. “As long as the demand is there, and there’s money to be made, traffickers are going to find a way.”

Cocaine use and overdose deaths are on the rise in the U.S. after years of decline as production has surged to record levels in Colombia, the source of about 90% of the U.S. supply.

Agents were doing another sweep Wednesday through thousands of containers on MSC Gayane, a cargo ship owned by Swiss firm MSC Mediterranean Shipping Co., but had not found any cocaine since their initial search on Monday, according to Stephen Sapp of U.S. Customs and Border Protection in Philadelphia.

Two members of the crew have been charged with conspiracy to possess cocaine aboard a ship, but details of their case are sealed.

An affidavit obtained by The Associated Press said that MSC Gayane was at sea off the west coast of South America when it was approached by more than a dozen boats loaded with cocaine. Crew members aboard the larger ship helped transfer the drugs, authorities said.

The cargo ship docked in Colombia, Peru, Panama and the Bahamas before arriving in Philadelphia early Monday. Federal authorities raided the ship later that day. The ship’s second mate was arrested after agents swabbed his hands and arms and detected traces of cocaine, an affidavit said.

“The 500 kilos that we got in March, good hit, good hit,” said Trainor, the Philadelphia DEA agent. “But was that a huge loss to the cartels? Probably not. But 15,000? Oh yeah. I’m sure somebody had a really, really bad day yesterday somewhere in South America.”

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Stressed-out workers spend $1,500 more on health care each year. Pets, yoga and sleep can change that: Former Aetna CEO Mark Bertolini

https://www.cnbc.com/2019/06/19/stress-adds-1500-to-annual-worker-health-care-cost-former-aetna-ceo.html

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Oh-Klahoma! 8 Questions J&J Should Ask Andrew Kolodny

https://www.acsh.org/news/2019/06/18/oh-klahoma-8-questions-jj-should-ask-andrew-kolodny-14100

The state of Oklahoma is smelling blood in the water and it is going after blood money. State Attorney General Mike Hunter has a very big “blood donor” in his sights: Johnson and Johnson, the maker and seller of opioid drugs, has been accused of deceptive marketing that contributed to the state’s addiction problem. J&J has a whole lot of blood – a market cap of $372 billion – and Oklahoma a whopping transfusion. According to the Wall Street Journal, the state is talking about approximately $17 billion for “abatement.”

“[The company] used a deceitful, multibillion-dollar brainwashing campaign’’

Oklahoma Attorney General Mike Hunter,  May 28, 2019 (Bloomberg News)

Not surprisingly, Andrew Kolodny, a tireless self-proclaimed expert on drugs and addiction, has been chosen to testify for the state. How could it be anyone else? If you take the news at face value Kolodny is not only the expert on opioids but perhaps the only person on earth even remotely qualified to speak about them -– which is, of course, a bunch of nonsense. 

This is why I’m offering J&J’s attorneys, eight questions that I would ask Kolodny if I had the chance. 

No charge.

(Before you accuse me of being a J&J puppet or lackey, perhaps you ought to read this: “Johnson & Johnson’s Shameless Exploitation Of The Opioid Crisis“. I wrote it earlier this year.) 

1. Opioids are used almost exclusively for control of pain. Do you have any formal training in pain management? Have you ever treated pain patients?

2. “When was last time you saw a patient? When was last time you prescribed a drug to a patient? What was the drug?”

3. “You and your organization PROP have recommended a 90 morphine milligram equivalents (MME) maximum dose per patient per day. Some states have enacted legislature based on MME limits. But critics have claimed that the concept of MME itself is flawed because of significant genetic variability in opioid metabolism from patient to patient. How do you answer those critics”? (1)

4. “All drugs have risks and benefits. Focusing on only the risks will necessarily give rise to an inaccurate portrayal of a given drug. What are the risks and benefits of alternative treatments for pain, such as NSAIDS, acetaminophen, systemic anti-inflammatory steroids, spinal injections, and gabapentanoids?” 

5. “You have repeatedly referred to prescription analgesics as ‘heroin pills.’ Are you stating that Vicodin or Percocet are equivalent in analgesic potency, addiction potential, and overdose risk to heroin?”

6. “Chronic pain patients, even those who have been treated successfully for years, are being forcibly tapered off their medicines. Are you in favor of forced tapering? If so, why? You have also stated that ‘the number of doctors who are inappropriately tapering pain patients is likely very small.’ Do you have data to support this statement? 

7. You have also stated that “'[pain patients are] being effectively manipulated to controversialize the CDC guidelines.” Do you have any proof or evidence to support this statement?”

8. “Will you, anyone in your family, friends or associates benefit financially from restrictions placed on prescription opioid drugs?”

Is Kolodny a believable witness, let alone an expert? I guess that depends upon how he answers questions like these. Assuming that Johnson and Johnson’s lawyers ask them.

Prediction: I have no idea what J&J did or did not do wrong, but the company is probably doomed no matter what. J&J has a big bull$eye on its back and Judge Thad Balkman, who will decide the case, is listening to a lot of bull. 

But I could be wrong. After all, this is not an expert opinion.

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At opioid trial, Johnson & Johnson moves to strike Oklahoma witness as ‘de facto member of State’s legal team’

https://legalnewsline.com/stories/512646956-at-opioid-trial-johnson-johnson-moves-to-strike-oklahoma-witness-as-de-facto-member-of-state-s-legal-team

NORMAN, Okla. (Legal Newsline) – Johnson & Johnson has asked the judge overseeing the first in an expected wave of trials against the opioid industry to strike the testimony of Dr. Andrew Kolodny, a psychiatrist who plays a central role in the State of Oklahoma’s case by linking narcotics marketing to opioid addiction and overdose deaths.

Calling Dr. Kolodny “a de facto member of the State’s legal team,” J&J said Oklahoma gave the Brandeis University researcher unfettered access to some 90 million internal documents obtained through discovery and used his expert testimony to “pollute the trial record with rampant hearsay, rank speculation, and the State’s own take on the evidence.”

Experts like Dr. Kolodny play a crucial role in the opioid litigation, since the plaintiffs – mostly states, cities and counties claiming to be seeking to recover opioid-related expenditures – appear to have settled on a strategy of “aggregate proof” under which they will present expert testimony, instead of specific examples, to show a connection between pharmaceutical industry practices and the increase in opioid abuse. 

Defendants like J&J therefore have a strong incentive to knock out these expert witnesses as unqualified.

Over five days on the stand, Dr. Kolodny touched on every element of Oklahoma’s case, including extensive testimony about how J&J’s ownership of a wholesale opioid ingredient business in Tasmania made it the “kingpin” of the opioid industry. Kolodny, co-director of Opioid Policy Research for the Brandeis University Heller School for Social Policy and Management in Massachusetts, also accused J&J of funding pain-treatment organizations and other groups he termed an “opioid Mafia.” 

In Dr. Kolodny’s pretrial deposition, taken two days after Oxycontin-manufacturer Purdue Pharma settled with Oklahoma, J&J says the physician for the first time discussed how the company’s Noramco and Tasmanian Alkaloids businesses “were the true cause of the opioid crisis,” instead of the widespread distribution of Oxycontin. 

The only opioid products J&J sold in Oklahoma were Duragesic, a fentanyl patch its Janssen unit introduced in 1991, and Nucynta, a pill it began selling in 2009. The company’s products represented less than 1% of Oklahoma Medicaid opioid prescriptions from 1996-2017.

Kolodny later testified in court that Purdue Pharma and its founding Sackler family “have been stealing the spotlight, but Johnson & Johnson, in some ways, has been even worse.” He also intimated, without specifically saying so, that J&J had coordinated with Purdue to produce a new strain of poppy rich in thebaine, a type of opioid, to supply expected rising demand for Oxycontin.

“This extended, free-form commentary about the State’s evidence over which the witness lacks both personal knowledge and expertise is not testimony at all, much less expert testimony,” J&J said in its filing. “It is advocacy, nothing more.”

No one from the office of Oklahoma Attorney General Mike Hunter was immediately available to comment. Kolodny testified he has been working as a paid expert for Oklahoma nearly full-time with the state for months. In testimony, he said his fee is in the mid-six figures.

Expert witnesses are intended to present opinions on complex matters to help the finder of fact, either a judge or jury, determine which party’s case is closer to the truth. Judge Thad Balkman has thus far refused most of J&J’s requests, perhaps most significantly refusing to put the case before a jury even though the state is seeking $17 billion in damages to clean up its opioid-related problems. 

Judge Balkman agreed with the State that the $17 billion isn’t money damages, which would require a jury trial if the defendant so wished, but money for “abatement” of a public nuisance. 

The state’s case is based upon a simple theory, reiterated throughout the trial by lead plaintiff lawyer Brad Beckworth, a private attorney whose firm has already reaped part of the $59 million in fees awarded in Purdue’s settlement with Oklahoma: “If you oversupply, people will die.” 

The State says opioid abuse was rare until 1996, when Purdue launched Oxycontin with the help of J&J’s wholesale opioid unit. It is calling experts like Kolodny to establish the cause-and-effect relationship, although it is not expected to call a single physician who relied on improper marketing to overprescribe opiates, or a single patient who received medically unnecessary opiates.

The state’s other expert witnesses have also displayed a thorough knowledge of their client’s case. In testimony yesterday streamed online by Courtroom View Network, Dr. Jason Beaman, chair of the psychiatry department at the Oklahoma State University Center for Health Sciences, mentioned another key legal talking point for the plaintiffs when he described the state’s “indivisible” injuries. Under Oklahoma’s rules for joint and several liability, J&J could be liable for the entire $17 billion opioid abatement tab if Judge Balkman finds its contribution to the crisis was indivisible from the activities of Purdue and other companies. 

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Drug Use by State: 2019’s Problem Areas

https://wallethub.com/edu/drug-use-by-state/35150/

Drug abuse has a long and storied history in the United States, and we’ve been “at war” with it since 1971 under the Nixon administration. But no matter who is in office, the federal drug budget continues to increase. It’s moved from $23.8 billion in 2013 to over $27.7 billion in 2018.

The current administration seems to be taking a hardline approach to drug use. In addition to the issue of drugs crossing the border from Mexico, President Donald Trump has been focused especially on the opioid crisis. The Trump Administration declared the crisis a national emergency. Congress also passed legislation last year aimed at providing support for people addicted and penalties for companies that contribute to overprescribing. President Trump signed this bill into law.

Given the uncertain future and lack of significant progress to date, it’s fair to wonder where drug abuse is most pronounced and which areas are most at risk in the current political climate. This report attempts to answer those questions by comparing the 50 states and the District of Columbia across 22 key metrics, ranging from arrest and overdose rates to opioid prescriptions and employee drug testing laws. Continue reading for the complete findings, commentary from a panel of researchers and a full description of the methodology used.

 Highest Drug Use by State

Red States vs. Blue States

Methodology

In order to determine which states have the biggest drug problems, WalletHub compared the 50 states and the District of Columbia in three overall categories: 1) Drug Use & Addiction, 2) Law Enforcement and 3) Drug Health Issues & Rehab.

Those categories include a total of 22 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the biggest drug problem.

We then determined each state and the District’s weighted average across all metrics to calculate its overall score. This total score was the basis for our final ranking. So the state ranked 1st in this study has the biggest drug problem, based on the data at hand, while the state ranked 51st has the smallest drug problem.

Drug Use & Addiction – Total Points: 50

• Share of Teenagers Who Used Illicit Drugs in the Past Month: Double Weight (~5.88 Points)
• Share of Teenagers Who Tried Marijuana Before Age 13: Full Weight (~2.94 Points)
• Share of Teenagers Offered, Sold or Given an Illegal Drug on School Property in the Past Year: Full Weight (~2.94 Points)
• Share of Adults Who Used Illicit Drugs in the Past Month: Triple Weight (~8.82 Points)
• Share of Children Who Lived with Anyone Who Had a Problem with Alcohol or Drugs: Full Weight (~2.94 Points)
• Number of Opioid Pain Reliever Prescriptions per 100 People: Double Weight (~5.88 Points)
• Number of Clandestine Drug Laboratories or Dumpsites: Double Weight (~5.88 Points)
  Note: The square root of the population was used to calculate the “Number of Residents” in order to avoid overcompensating for minor differences across states.
• Overdose Deaths per Capita: Quadruple Weight (~11.76 Points)
• Overdose Deaths Growth (2017 vs 2016): Full Weight (~2.94 Points)

Law Enforcement – Total Points: 25

• Drug Arrests per Capita: Half Weight (~2.78 Points)
• Drug Arrests on College Campuses per 1,000 Students: Full Weight (~5.56 Points)
• Prescription Drug Monitoring Laws: Full Weight (~5.56 Points)
  • 1 – States with a prescription drug monitoring law that requires doctors to consult an opioid prescription database before prescribing painkillers.
  • 0.5 – States with a prescription drug monitoring law that does not require doctors to consult an opioid database.
  • 0 – States with no prescription drug monitoring laws.
• Maternity Drug Policy (Is Substance Abuse During Pregnancy a Crime?): Full Weight (~5.56 Points)
• States with Employee Drug Testing Laws: Full Weight (~5.56 Points)
  • 1 – Authorized
  • 0 – Currently Not Available

Drug Health Issues & Rehab – Total Points: 25

• Share of Adults Who Couldn’t Get Treatment for Illicit Drug Use in the Past Year: Triple Weight (~6.82 Points)
  Note: This metric measures the share of adults who needed but didn’t receive treatment for illicit drug use in the past year.
• Substance Abuse Treatment Facilities per 100,000 People Using Illicit Drugs: Double Weight (~4.55 Points)
  Note: This metric considers people who are at least 12 years old.
• Admissions to Substance Abuse Treatment Services per 100,000 People Using Illicit Drugs: Full Weight (~2.27 Points)
  Note: This metric considers people who are at least 12 years old.
• Naloxone Availability without Individual Prescription: Full Weight (~2.27 Points)
  Note: Naloxone is a safe and effective antidote to opioid overdoses. This is a binary metric.
  • 1 – Naloxone is available without individual prescription
  • 0 – Naloxone is not available without individual prescription
• Drug Treatment Programs Availability for Pregnant Women: Full Weight (~2.27 Points)
  Note: This binary metric measures the availability or absence of drug treatment programs for pregnant women in a state.
• Share of Addiction Treatment Medication Paid by Medicaid: Full Weight (~2.27 Points)
• Narcotics Anonymous & Alcoholics Anonymous Meetings Accessibility: Full Weight (~2.27 Points)
• Substance Abuse & Behavioral Disorder Counsellors per Capita: Full Weight (~2.27 Points)

Sources: Data used to create this ranking were collected from U.S. Census Bureau, Bureau of Labor Statistics, Centers for Disease Control and Prevention, Federal Bureau of Investigation, Substance Abuse and Mental Health Services Administration, U.S. Drug Enforcement Administration, Child and Adolescent Health Measurement Initiative, Project Know, the Pew Charitable Trusts, Guttmacher Institute, OHS Health & Safety Services, CVS Health, IMS Institute for Healthcare Informatics and Recovery.org.

Image: Photographee.eu / Shutterstock.com

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“I believe I am a danger to the public working for CVS.” – Anonymous CVS Pharmacist — Part ONE

http://pharmacistactivist.com/2019/June_2019.shtml

They Must be Anonymous, But They Will Not be Silent!

The title for the editorial commentary in the May issue of The Pharmacist Activist is, “I believe I am a danger to the public working for CVS.” That is a quote from a letter from an anonymous (but known to me) CVS pharmacist to a board of pharmacy. I have received so many responses to this issue, the majority of which are from current or former CVS pharmacists, that I am using this June issue to include excerpts and examples from the responses. With several responses, I have made minor editing changes to prevent the identification of the pharmacists who voiced the concerns, but the importance and strength of their concerns are not changed.

I would also reiterate that there are thousands of excellent pharmacists who work in CVS stores, and the concerns identified are not a criticism of them but, rather, are to support them by increasing awareness of conditions and situations that they can’t even communicate within CVS because of their fear of being terminated. It is the CVS management-imposed metrics, working conditions, and understaffing that place consumers at risk and are the basis for this criticism.

Responses

From current CVS pharmacists:

“Subject: CVStress. All of what the anonymous pharmacist said is true, but there is more. Recently, CVS started a program where electronically sent prescriptions may be verified by another CVS store within the state. It is my feeling that eventually pharmacies will be operating without pharmacists. Everything will be done by some communications methods. I firmly believe this is what the chains want. Imagine the profits then!! This is part of the reason they are pushing to get their employees to be named to state boards of pharmacy. I’ve worked in hospitals, independents, and chains. My hours were cut and I didn’t know about it for 2 weeks until after the starting date for the change. There is no more profit sharing. No more premium pay for covering extra shifts. Our health insurance premiums have skyrocketed. Working conditions are worse than you can possibly imagine.
    While all of the above causes a financial and emotional hardship for me, the real people who suffer are the patients (customers to CVS). They are not getting the care and attention they deserve. They get bombarded by text messages and phone calls almost begging them to come in and spend their money. I have no time to do anything that I know I should be doing. I never thought I’d say this, but I can’t wait until my retirement. I truly enjoyed being a pharmacist but now I’m just a highly paid robot who feels more like a liability than an asset to my employer.
    What am I doing about it? I recently spoke with a pharmacy student with whom I work who was planning on working for CVS following graduation. I explained my experiences and feelings about working for CVS, and the student obtained another position and will be much better off. It may not be a lot, but everyone can do something. You may use any of this information you wish and I know you will respect my request for anonymity.”

“I am losing my full-time status in my store and will have to pick up a shift elsewhere to stay full-time. Cuts and closures are happening everywhere. As pharmacist cuts occur, more techs are added and the tech: pharmacist ratio is far beyond the limit allowed in my state.”

“I am aware of a pharmacist who is opening an independent pharmacy that will be near a CVS store. However, Caremark is purposely delaying the application into its provider network. Because this is a heavy Caremark provider area, a new pharmacy would have great difficulty opening without Caremark plans. Caremark is doing everything they can to delay the opening of new independent pharmacies, so that they can keep their profits in-house.”

“Another scam, or as CVS would like to say ‘patient care calls.’ Added to our duties are 10 or 15 calls per day designated as pharmacist special message calls. We are to call patients and tell them that the pneumonia shot the doctor ordered is waiting for them at the pharmacy and to come on in to get the shot.”

(Editor’s note: I contacted this pharmacist and asked whether there were doctors’ orders for the vaccine for specific patients. His response is below.)

“There are no doctor orders. We use one doc, as for all injections. CVS selects patients who are age appropriate and may be at risk. The way I have been handling this is asking them if they have any questions about meds and that this is a general call and that we appreciate them as a customer. I also tell them that we are offering pneumonia shots, and many respond that they have already had the shots.”

“We get screamed at by customers because their prescriptions are not ready when promised. We get behind and the CVS response is ‘too much red in this store today.'”

From pharmacists previously employed by CVS:

“I was let go from the company for ‘business purposes’ when district revenues were down. At least that’s what I was told. However, I and others believe that CVS and some other chains are looking for reasons to fire older pharmacists. The work environment, stress, and inability to keep up with company metrics are only a few factors which contribute to an unsafe environment. I have many stories. Even when I was let go, I had to fight for my final paycheck and stock purchase withholdings.
    Although I no longer work for CVS, I choose to remain anonymous at this time because I am concerned CVS will find a way to retaliate. However, there is a need to expose the truth. I once heard a sermon in which it was stated: ‘To sit and watch evil IS evil.’ Somehow, that thought keeps going through my mind.”

“Since the time I retired from CVS, I have stayed in touch with my friends there. CVS lost a number of pharmacists in our area in just two months. They still can’t find technicians and many who have been there for years are leaving. Customers are extremely unhappy with service and prices. There is no help.”

From a board of pharmacy member:

“I will be bringing this up at the next board meeting.”

From a former hospital pharmacist:

“What you describe in the May issue of The Pharmacist Activist is not unlike what occurs thematically in hospital pharmacies. I am SO glad that I’m out of that mess! I feel (and am) betrayed by our profession after all the work I put into it.”

From an executive of a company that works closely with pharmacists:

“I empathize with all these pharmacists. Many of these chains and supermarkets have their performance metrics. That is bad news. There is even worse news!! Many State Boards of Pharmacy are CONTROLLED by the chains and supermarkets!! They have ‘their own people’ in place to knock down any and all complaints that come in that would adversely affect anything that the chains and supermarkets are doing!! I was shocked to learn that it does no good at all to complain to the Boards of Pharmacy.”

From customers:

“I am so grateful to be back at Skippack Pharmacy! Between Express Scripts and CVS, I had enough. I was so tired of having no eye contact. Made me wonder if one of my pills fell on the floor, would they pick it up and put it in the pill bottle? Mayank (the new owner who reopened Skippack Pharmacy after CVS bought and closed it) is great and we love having him here.” (Editor’s note: Please also see the separate commentary about Skippack Pharmacy in this issue.)

(Editor’s note: I also received many other responses voicing criticisms regarding CVS, but the comments provided above are representative of the concerns communicated to me. The comment below is the single response I received that is complimentary of CVS.)

“My experience at a local independent pharmacy was unsatisfactory, and I went to a CVS that I now patronize exclusively. The pharmacists and techs all wear white uniforms. When I have new prescriptions, the pharmacist, without being asked, always presented me with the new drug and asked if he or she could explain. I have found the personnel at our local CVS to be very professional.”

From a producer of a television news program:

“Do you think the CVS pharmacist you wrote about would go on camera?”

I informed the anonymous pharmacist I quoted, as well as several other current CVS pharmacists who have voiced concerns to me, of the television producer’s question. They declined to be interviewed on camera because they anticipate CVS would terminate them and there are not other positions for pharmacists available in their areas. I then contacted pharmacists who have voiced concerns, but who no longer work for CVS. Even these pharmacists are not willing to be interviewed on camera because they are concerned that CVS would find a way to retaliate against them. I responded that I understood their concern and assured them I would not place any pharmacist at risk by disclosing their identity. Another pharmacist with whom I communicated had been a pharmacist manager with CVS for several decades before he was terminated. He sued CVS and, following an extended legal battle, was successful in receiving a large settlement from CVS. I do not know the specifics of the settlement because CVS insisted that the terms of the settlement be confidential as a condition for the agreement. Therefore, the information is not publically available and the pharmacist is restricted from disclosing any information.

I asked the television news producer if interviews could be conducted in a manner that would disguise the identity and voice of those interviewed. He did not anticipate that this would be done, but is looking into it and the outcome is pending.

I wish to express my appreciation to the pharmacists who have had the courage to communicate their concerns to me and for their trust in me to protect their identity.

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