The DEA’s crackdown on pain meds
Federal authorities are facilitating a proxy war between doctors and pharmacists, and patients are caught in the middle
http://america.aljazeera.com/opinions/2015/12/dea-crackdown-on-pain-meds.html
Over the summer, a federal appeals court in Washington state ruled that pharmacies do not have a right to refuse to fill a patient’s prescription on moral grounds. The plaintiffs in the case, Stormans v. Wiesman, were three pharmacists who denied emergency contraceptives to dozens of female customers, saying that doing otherwise would violate their Christian principles.
While the ruling served as an important test case for the Religious Freedom Restoration Act, the likelihood of a religious fanatic trying to come between you and your medication is minuscule compared with the threat posed by well-meaning public officials who think the best way to prevent people from getting addicted to prescription drugs is to make them harder to get for everyone.
I wrote about the ancillary impact the war on drugs is having on patients back in 2013. We now have a clearer picture of the scope of that collateral damage, and it’s worse than even I expected.
Over the past four years, reports of pharmacists refusing to honor valid prescriptions for controlled substances have grown considerably as blame for America’s opioid addiction crisis has fallen increasingly on health care providers.
Media reports such as the recent “60 Minutes” segment “Heroin in the Heartland” have helped stoke the hype against narcotic medications without adding necessary context. But federal drug policy has done the most damage. For the past five years, the Drug Enforcement Administration has been orchestrating a high-stakes proxy war between physicians and pharmacists, creating tens of thousands of opioid refugees in the process.
“Opioid refugee” is the term doctors, pharmacists and patient advocates use when referring to pain patients who have been left adrift by physicians who no longer want to deal with the hassle of writing prescriptions for narcotic pain medication and by pharmacies so fearful of sanction that they will use any excuse they can not to fill them.
As usual, poor, minority and elderly patients, many of whom already suffer from inadequate access to opioid analgesics, have been the hardest hit. An investigative report that an Orlando, Florida, news station aired this year determined that some pharmacists now go so far as to flag prescriptions for controlled substances by ZIP code — the equivalent of medical redlining. Many of these patients are now forced to travel miles and visit multiple pharmacies each month is search of medication. Others are subjected to regular trips to hospital emergency rooms during gaps in medication availability.
From patient to ‘drug seeker’
The opening salvo in the DEA’s campaign can be traced to 2010, when it issued a decision that greatly expanded the guidelines for corresponding responsibility — a decades-old federal mandate that requires drug dispensers to ensure that prescriptions for controlled substances be issued for a “legitimate medical purpose.”
The decision codified a list of red flags that pharmacists dispensing controlled substances could be held responsible for ignoring. One of these red flags vaguely targets medication orders that include “combinations generally known in the medical and pharmacy profession as being favored by drug-seeking individuals.”
In theory, the policy is designed to add another check in the process of preventing drug abuse and diversion. In practice, it means that after your physician diagnoses your condition and writes you an order for medication, you may be subject to a second diagnosis delivered across a counter by a virtual stranger who won’t so much as take your pulse before determining the validity of your prescription.
Since instituting its crackdown on pharmacies, the DEA has filed actions against hundreds of retail and wholesale drug dispensaries. In some cases, they shut down legitimate pill mills that were operating virtual narcotics drive-throughs. But in most cases, pharmacies and wholesalers are targeted for exceeding what the DEA considers average dispensing numbers for certain types of drugs.
Exactly how these averages are determined and what it takes to show up on the DEA’s radar are unclear. (I’ve filed a Freedom of Information Act request in an attempt to find out.) But the bulk of federal efforts have focused on the Deep South — which has suffered from an epidemic of opioid abuse but also happens to account for among the highest rates of cancer diagnoses, cancer deaths and hospice patients in the nation. In other words, these states are home to an above-average number of sick people.
Meanwhile, at least three major drug wholesalers have responded to aggressive federal enforcement efforts by establishing arbitrary monthly rations that limit the amounts of controlled medications that each pharmacy may purchase. According to one survey from 2013, three-quarters of pharmacies experienced three or more delays or issues caused by stopped shipments of their controlled substances over the past 18 months. In more than two-thirds of those cases, pharmacists could not obtain replacements from alternative suppliers.
Implausible deniability
Stunningly, the DEA has repeatedly gone on record denying that it is part of the problem.
But connecting the dots between federal drug enforcement efforts and the opioid refugee problem is easy. For example, in 2014 — less than a year after Walgreens was fined a record $80 million by the DEA over accusations it overdispensed painkillers, including oxycodone and hydrocodone — a concerned Walgreens pharmacist leaked a secret internal checklist the company had begun using that included exceedingly strict guidelines for dispensing.
Among other things, the rules required pharmacists to deny prescriptions if the person filling it was on their medication for more than six months, had never been to the store before or paid cash for their medicine (which, as a freelance writer, I did for years before acquiring health insurance this year under the Affordable Care Act).
A recent federal audit further undermines the DEA’s claim that it’s not getting in the way of legitimate patients and their medicine. In July the Government Accountability Office issued a report on DEA policies on prescription drug abuse and found that while the agency’s enforcement actions have helped decrease prescription drug abuse and diversion, they have also helped decrease actual medical treatment.
“Over half of DEA registrants have changed certain business practices as a result of DEA enforcement actions or the business climate these actions may have created,” the report stated, adding that these changes have “affected their ability to supply drugs to those with legitimate needs.”
Rationing of care
The blowback has been devastating. Scores of local and national media reports over the last 18 months have described the living hell that patients are being subjected to as a result of artificial drug shortages facilitated by federal policy.
One pharmacist from Jacksonville, Florida, told a reporter for Kaiser Health News in August that he sometimes turns away 20 patients a day because of dispensing thresholds imposed on him by the DEA. “We’re being asked to act as quasi-law-enforcement people to ration medications,” he said. “I have not had training in the rationing of medications.”
Some states now appear ready to double down on the war on patients. In October, Massachusetts Gov. Charlie Baker proposed a bill to the legislature that would prohibit physicians from prescribing more than 72 hours’ worth of pain medication. Doctors and patient advocates have blasted the measure, and the American Medical Association has warned it could have “unintentional consequences to the patient-physician relationship.”
That plan may be terrible policy, but it addresses what by all accounts is a legitimate issue. More people are abusing narcotic painkillers, and more people are dying from them. But fundamental misunderstandings of the nature of the problem are leading us down a path we can’t afford to take.
One of the biggest is the all-too-common myth that drug dependency, a physical condition, is the same as drug addiction, an obsessive-compulsive disorder that may or may not include physical dependency. All patients who receive regular doses of opioid painkillers will become physically dependent over time; only a minority will ever fit the diagnostic criteria for addiction.
Unfortunately, to get to that minority, we’re forcing more and more people into real danger. Sick people denied proper care are inclined to self-medicate. In the case of opioid refugees, this frequently means turning to adulterated street heroin — a far more nefarious substance than prescription pharmaceuticals. We have a better chance of saving their lives if we let doctors take the lead rather than armed federal agents.
We are currently in the midst of one of the most conscientious dialogues in decades about the sensibility of U.S. drug control policy. Yet instead of a real shift in strategy, there is ample evidence that we’re simply diverting resources to another front. How many more innocent people need to suffer before we realize that the war on drugs is a failed strategy, no matter where we choose to point the cannon?
The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera America’s editorial policy.
Filed under: General Problems
I am a chronic pain sufferer due to severe osteoarthritis, advanced spondylosis and degenerative disk disease. I am unable to work due to pain. I am a disabled vet. I get most of my health care from the VA, but due to VA doctors attitude regarding the value system of: It is better to let someone suffer then to prescribe pain meds, I have to get prescriptions from my non VA doctor who has known me for eight years (4 of which were before I had any pain so he has treated me for years of me being healthy). Because I have no commercial health insurance I pay for my pain meds cash. Ding, ding, ding. Bells and whistles at the pharmacy. Every time I get a prescription, I fear being given any number of reasons why I can’t purchase my meds. I am not a junky. I am a disabled veteran, who worked since being 16 years old and worked 40 years of his life who now has severe health problems and I think I deserve some level of comfort, not to be stuck barely able to move and crying in agony most of the time.
I was on opioid therapy for about 10 years, so I know that fear — every month wondering if my prescriptions would be filled. Daily monitoring and recording of my pain levels and every single pill I took. Wondering if my doctor would think I wasn’t improving on the medications; fighting for the medications that worked best for me; spending years on antidepressants that had no effect or only made me depressed. I was addicted to the medical industry and dependent on doctors to manage my pain.
I’m not suggesting this for you, but I chose the path of medical cannabis, and I can’t tell you how GREAT it feels to be independent again. Of course, bud doesn’t work for everyone; it’s expensive; and it’s hard to find strains that are strong enough for my pain. But all the hassle of medical cannabis in no way compares to the stress of depending on doctors. I AM FREE! And I wish the same for you, no matter which treatment you choose.
Believe it or not, the “Health Care Reform Bill” was adopted from a theory from a Harvard surgeon turned psychiatrist named Dr. Ronald Heifetz. His belief, [from secret emergency drug testing in ERS is that most people on disability are really just ADDICTS, hence the “Well ness and Recovery model/Act.
No-one mentions [germ-warfare], agent orange, pesticides…..[my cousin became disabled from the mandatory vaccines given before he was deployed to Afganistan. My other cousin died from disease caused by agent orange while serving in Nam; his actual diagnoses was Non Hogkins Lymphoma.
Someone may find the book Lab 257 interesting in terms of FDA, Homeland Security, and the relationship between Plum Island which is perpendicular to Lyme CT.
We put animals “to sleep” who are suffering, yet with all the technology, [certain Gov agencies brag about how they can detect cancer from a satelite], And yet one of the most sensitive infectious disease labs, [besides the military ones] in Palo Alto CA will not accept most insurance.
AS I am in the “prime of my life”, and am having to fight for quality and what was CHEAP medications, created for people with chronic illness; pain mgt told me that “Tylenol” will kill your liver and Ibuprophen will kill your kidneys”, so why is this issue a war in itself ?
My personal feelings are that the more people who are too sick to vote or come together as a group; the more fear and power “they” hold over the majority. This is a disgusting, pathetic, and a “CLASS ISSUE”, also, at this point, an obscene diversion from what else is truly going on from the power-elite.
When I am deprived of contributing both to myself and society solely as a result of a warped propaganda which mixes up Addiction with validated and proven diagnoses [including the waste of additionally having to exert much needed energy and time], defending myself and my body from unethical, misrepresented, and non-standardized FDA-approved MEDICATION assaults, this alone is a crime against humanity, which is quickly evolveing into an EMERGENCY global crises.
This is insane. I don’t have a clue as to who are receiving medications so powerful as to cause an overdose when my pain medication, or “substituted for” oxycodone isn’t authentic to the point where it caused more pain and had to be returned; it was so toxic as to be an emergency situation with a set of side-effects never experienced before in my life. like: my throat closing-up and sticking together, intense shooting waves of unbearable pain up the left side of my brain, to where I could point my index finger to the spot that was about to explode. Besides increased and localized pain, extreme dehydration-to where I couldn’t speak w/o multiple glasses of water, and another effect causing severe insomnia; I had to switch-out to another “substituted For” whose active ingredient must be one of those 40% less. I am having to buy additional aspirin & benedrill. To add insult to injury I am being denied authentic medication for ADHD and being penalized for writing letters to state commissioners regarding the multiple returns of non-standardized, and misrepresented medications that have nearly killed me and caused 3 heavy metals, severe edema, 30# weight gain, high liver enzymes, and a “life” of pure hell-just trying to receive authentic and adequate medications for two chronic illnesses. I can not and will not exist in this 24/7 nightmare anymore. When I hear these stories about people overdosing on prescription medications I wonder what world do they live-in. Since the “shortages” began, my once hopeful life evolved into a revolving door of hell, pain, and shock that this is really happening, and it’s all under a veil of secrecy, fear, and more sadists than I ever believed possible. Being punished for having chronic illness and at the mercy of unethical and corrupt “officials” is surreal; the irony is if a person admits they want to end their hell, they will be punished and “imprisoned” for that as well. I would think they would be happy as the depopulation plan lets them off the hook, but sadists thrive off of the suffering of others.
Joy, were you given one of those abuse-deterrent formulations of Oxy?
All I know is that my prescription is written for oxycodone. The pharmacy closest to me fills it. It was first brought to my attention that this [KVK] “substituted for” oxycodone brand almost gave my sister a stroke after one pill; [my sister has chronic Lyme disease, was on a pic-line for 6 mos, then was re-infected again with Bartonella, and is not being treated at all going-on two years now. We are 2nd highest in the nation, Dutchess Co. being # 1. My nightmare began trying to figure-out what was wrong with my sister as I knew it wasn’t late-onset schizophenia, and simultaneous left flank pain-so severe as to incur bi-weekly ambulance rides. I have co-existing diagnoses and was adequately treated for 10 years with a generic BARR stimulant which was a Godsend along with percocet at the time for severe stenosis, herniations, and tumor which may be cancerous and result in amputation. Long story shorter, btwn my research and attempts at finding advocacy for my sister-who-was on deaths door, seeing how broken “the system” truly is, and entering the political twilight zone called lyme-disease, I almost lost my mind. Finding-out that the Non-Profits, [whose whole existence was to help support those who couldn’t], were told by local politicians not to help us as to make us become “more resilient”, I’m grateful my sister was a little more stable and given appropriate and AUTHENTIC opiate medications before IT happened to me.
Sorry for the rant. Being w/o authentic medications, [no adhd meds at all], and experiencing these toxic substances labeled “Substituted For” oxycodone, [I’ve returned two, as well as 6 dextroamphetamine sulfates, Adderalls, and a brand-name Zenzedi. Big-Pharma, like the banks, seem to think they are too big to fail. I know I am being monitored via “smart” meters, internet, phone, but I don’t care. I will never conform, adapt, or crawl on my hands and knees, pretend to be someone I’m not, I have been terrorized by this covert regime for too long now, and watching my only sister slowly die, deteriorate, forget how to get home, and lose any hope of having a “normal, healthy, & independent life, makes me want to throw-up all over this corrupt to- the- core AUTOMATED SYSTEM. I have no desire to MEASURE-UP TO ANOTHER HUMANS STANDARDS, [especially trying is the semantical, Hi-tech, and psycho-war games], as I’m lying in bed, in pain and disbelief for weeks and months Does anyone know if N.Y. is the only state where pharmacists are immune from lawsuits due to death or injury directly related to medication ingredients as they are not allowed to know ? This is a fact 6 independent pharmacists admitted it when directly asked. .
It took me 4 mos to write the N.Y.S. Commissioners of mental health about the “counterfeits”, Placebos w/ side-effects. I see how terrorized my primary dr. is, along with the outright denial, lies, conformance, bribery, [I myself was offered a job to spy on the post office], I ignored it. I ask everyone I know who is on a script if it
Thanks for your detailed response, Joy. I was unfamiliar with the KVK brand of Oxy, but it appears that many other patients are having the same problems:
http://www.medschat.com/Discuss/kvk-tech-oxycodone-30-mg-265090.htm
http://www.medschat.com/Discuss/kvk-tech-oxycodone-30mg-IR-262212.htm
Oops! Your comment just showed up. 🙂
Imagine my inability to respond to a senior paralegal at Empire Justice in Albany, N.Y when I asked “What are my basic human rights as an American Citizen living in the state of N.Y. ” ? her reply “I can’t answer that question as that is a philosophical one”
I wonder which definition of philosophical she was referring to?
1. relating or devoted to the study of the fundamental nature of knowledge, reality, and existence; or
2. having or showing a calm attitude toward disappointments or difficulties
When the DEA is involved, you obviously have no rights. And I can’t imagine there is even one attorney who wants to pick a fight with the DEA (unless they work for the ACLU).
I made a few comments on this article and was just wondering why I didn’t see any from you? Your voice carries a lot of weight…