PHARMACIST STEVE

From my INBOX:

Heroin use does not “usually begin with the use of legally prescribed opioid pain killers” and studies bear this out. The rate of addiction (3-6% of the population) and misuse of prescription medications by Chronic Pain Patients (CCPs = 30-34% of the population) is no greater than all forms of addictions in the general population. Drug seeking behavior / addiction is a mental illness and very few addicts obtain their abused substances through legal means. They obtain the prescription meds from illicit sources and while an argument can be made that greater legitimate prescribing / dispensing can result in greater diversion and hence abuse the link of addiction to legitimate prescribing/ supply use can not be made.  Continued focus on the addiction side of the story rather than the CPP population leads to denied access to those in need.

 Here is a link to an NIH study with sub-links related to this subject:

 

https://www.ncbi.nlm.nih.gov/pubmed/18489635

What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-rela… – PubMed – NCBI www.ncbi.nlm.nih.gov Pain Med. 2008 May-Jun;9(4):444-59. doi: 10.1111/j.1526-4637.2007.00370.x. Meta-Analysis; Review

The irony in the Florida DOH letter titled ” Emerging Health Threat” indicates that the DOH views restricted supply and access to needed medications, in this case Hydromorphone, as a “threat’ to public safety yet they turn a blind eye and ignore aggressive and overzealous big pharmacy corporate policy making decisions that deny access to needed medications to patients with legitimate medical needs. CVS, Walgreens, and Walmarts blacklist certain prescribers as “inappropriate” and their computer systems prevent the filling of any prescriptions from these prescribers even if the patient has legitimate medical need for the medications. The prescribers are usually first blacklisted simply by the number of controlled prescriptions written as a percentage of the whole. The DEA scrutinizes any doctor who writes a high number of controlled prescriptions even if that doctor is specialized in pain management and in due course would in fact write a high number of controlled prescriptions in the specialty practice. The same applies to pharmacies that fill a high number of controlled prescriptions and once the percentage reaches 20-30% red lights go off at the DEA for scrutiny. This leads to irrational fear of DEA sanctions by the corporations and implementation of the policies that “threaten” public health and safety for the CPPs in need. It is bit of a”Catch 22″ scenario.

 

The implementation of corporate policies to protect company interests that limit access do so by usurping and interfering with the individual Pharmacist’s Professional Judgment. Even if this highly educated professional, trained to critically access and vet each individual controlled prescription for validity and medical necessity, deems the unique patient and the patient’s health status / diagnosis as legitimate the Pharmacist is coerced to refuse that valid prescription and refuse access to needed care. This coerced refusal is done by fear of retribution and loss of employment. The conflict of interest between corporate protectionism and the ethics of the profession of pharmacy in which Pharmacists are sworn by oath to “relieve pain and suffering” only does disservice to those patients in need.

 

The interference with a Pharmacist’s professional judgment is an act disallowed by any entity in Florida Pharmacy Laws and Rules. https://www.flrules.org/gateway/readFile.asp?sid=0&tid=16866377&type=1&file=64B16-27.831.doc. Several more points of  Florida Pharmacy law prohibit any interference as well. Interference with the professional judgment of a Pharmacist’s professional judgment is subject to disciplinary action and fines but the DOH and MQA take no action against the corporations even when the residents of Florida are inappropriately denied access to care. The mission of the DOH is to protect the people and the integrity of the various professions but it fails miserably. 

 

The coerced refusal to fill valid and legitimate prescriptions mandated by corporate policy has the consequence of violating Patient Rights’ as spelled out in State and Federal guidelines for Medicare, Medicaid and American Disabilities Act. The corporations force the Pharmacists to violate Patient Rights and violate these laws which has potential personal liability for the Pharmacists who can be sued individually for those violations by the patients. If that were to occur, and it has, I am certain the corporation would deny all responsibility. The Centers for Medicare/Medicaid Services (CMS) and Florida Medicaid are aware of these practices by the corporations yet while charged with protection of the people and their Rights also fail to take any action to do so.

 

The heroin epidemic regardless of why it is occurring and having reach the current level of attention has done great harm to the CPP population. These patients are treated like criminals in their attempts to gain access to needed medications. Sometimes good people with legitimate needs end up at the office of a “dirty” doctor as that’s their last resort.  In their situation they have often lost their jobs and insurances and lack adequate transportation to get to better and needed care. They spend an inordinate amount of time doing the “pharmacy crawl” trying to find a pharmacist / pharmacy that will help them. These patients lack the resources to reach the best care of certified pain management clinics, physical therapy, psychological care, surgical care and addiction treatment if needed. Obtaining some medication that affords them some quality of life is all they have.

 

The pharmacist in fear of retribution from employers and unwarranted scrutiny by the DEA refuse to maintain adequate inventory to help the patients. The corporations don’t count the controlled prescriptions in calculating pharmacists work so many pharmacist feel why bother if they don’t get credit for the work. The Chronic Pain Patient story is the story that should be told.

 

Filed under: General Problems