My Inbox Today…. This is a letter sent to Patrick Kennedy at the FL BOP
I live Florida. I have degenerative disc disease with compression on nerve roots , neck injuries and more and now some kind of plasticity and red bone marrow transformation in my spine myeloma a rare bone cancer has not been ruled out and the pain is at a level 8-10 with out proper medication , I was denied my pain medicine from December of 2013 to 6 17 2014 when I went to the pharmacy to get my prescription filled the pharmacist asked what was wrong with me so while telling the pharmacist of my red bone marrow transformation and possible cancer she just rolled her eyes as she looked at me and took my prescriptions and said I will try to fill your prescriptions and then turned around and black balled me in the Walgreens system for 3 months after calling my doctor knowing of the bone marrow and other conditions making it so i could not get my pain medication filled at any Walgreens , finally the doctor wrote me a note to give to the pharmacist explaining my condition and the pharmacist told my doctor to cut my dosage or I would get nothing knowing the milligram i was taking prior in December of 2013 . I am in constant pain and at the point that i do not care what happens to me , what kind of a world is it when you go for treatment and get nothing but lied to by a health care professionals I thought they took a oath ,I am treated like it is wrong to have a disability or to be hurt having the pharmacist telling you what you will be allowed and not care if you are left in excruciating pain, I do not know what departments to file a complaint with or who to contact on this issue for help
Does forcing a pt to live in a level 8-10 pain sound like TORTURE ? Does having a Pharmacist tell a doctor to cut the pt’s medication OR ELSE.. sound like PRACTICING MEDICINE WITHOUT A LICENSE ? The AMA has already warned Pharmacists about this http://www.ama-assn.org/ams/pub/amawire/2013-june-19/2013-june-19.shtml
Here is the BOP’s response:
Thank you for your email to the Florida Department of Health regarding your concerns with your recent interaction with a licensed pharmacy. As Executive Director for the Board of Pharmacy, the entity that regulates the practice of pharmacy in Florida, I have been asked to respond. I am sorry to hear about your medical conditions.
In recent years the Florida Legislature has made a number of changes in regard to the treatment of chronic nonmalignant pain. These changes were made as an effort to prevent the growing abuse of pain medications. When making these changes, however, the Legislature sought to balance the needs of patients with medical conditions and the safety of Florida’s general population.
In regards to your concerns with pharmacies’ refusal to fill your prescriptions, there is nothing in in this legislation that would prohibit the pharmacy from filling your prescriptions. Please be advised that pharmacists are directed to exercise their independent professional judgment when filling prescriptions. Pharmacists are also required to monitor a patient’s drug therapy and to work with the patient’s prescribing health care provider. It is possible that the refusal to fill your physician’s prescriptions is a policy of the pharmacy corporate office. . If you wish to file a complaint against a pharmacist please visit our website at http://www.doh.state.fl.us/mqa/enforcement/enforce_home.html.
We are aware that the availability of prescription medications in Florida can be difficult, and we support efforts at the state and national level to address this issue. However, we remain committed to ensuring that the practice of pharmacy in Florida is conducted in compliance with Florida law.
Again, thank you for sharing your concerns. If you have any questions, please contact me at (850) 245-4197 or Patrick.Kennedy@flhealth.gov.
Sincerely,
Patrick Kennedy
Executive Director
Florida Board of Pharmacy
It is possible that the FL BOP is allowing – or turning a blind eye – to a corporation’s policy in to how/when a prescription is to be filled/rejected – Doesn’t this sound like PRACTICING PHARMACY WITHOUT A LICENSE ?… or perhaps… INTERFERING WITH THE PRACTICE OF PHARMACY ? Yet the BOP suggests that this pt files a complaint AGAINST THE PHARMACIST !
Sure.. this is… the practice of pharmacy in Florida is conducted in compliance with Florida Law…??? Last time I looked… a permit holder -ie chain pharmacy – is only licensed to operate a Rx dept… when there is a properly licensed Pharmacist that has agreed to be PIC.
It would seem.. that if you are a Pharmacist licensed in Florida.. the BOP is allowing your employer to “set the rules” without consequences.. at least for your employer.. but… perhaps not so much for you.. But then the enforcement arm of the BOP is the state’s AG.. and we all know that the FL’s AG is one of the biggest OPIOPHOBES .. so when it comes to controlled drugs… she is going to probably turn two blind eyes to the issue… because she apparently doesn’t see a problem with letting many of the voters in FL to live in pain…
There is a estimated 19 million people in FL… which would suggest that there are some SIX MILLION that are suffering from chronic pain in FL… IMO.. would not take a large per-cent of those voters to change the outcome of this Nov’s election in FLORIDA … and share their pain with those that are seeking to get elected or reelected…
Filed under: General Problems
If I supposedly ‘order too many CII’s ” but yet I have legit scripts to justify those orders, I should be able to order the quanities I need to fill them.So the DEA is either putting order quotas on Ciis and they are being untruthful to the contrary or the wholesalers have no backbone and are limiting the orders on their own and using the DEA as an excuse. Someone needs to fess up. I understand the DEA puts manufacturing quotas on controls, so often at the end of the year, we may come up short. (ie Adderall a couple of years ago) One might question if this also could be considered ‘restraint of trade” The DEA is interfering with my being able to provide my patients with their duly prescribed medications. Imagine the uproar if this were heart, diabetic, or blood pressure medications..The public wouldn’t stand for it. So the chronic pain community needs to get loud…remember ‘squeaky wheel gets the oil” That’s how we have all these cancer awareness, diabetic awareness, etc Wait until the veterans are given the vouchers to use the community pharmacies for their meds….until the VA is straightened out…then watch all H**L break loose on pain management.
Steve….Besides ‘Fast Metabolizers’ which I know, there are also ‘Pseudoaddictive Behaviors” (unless we’re talking the same thing but different terms) which happen when a chronic pain patients pain is undertreated or no longer controlled on the current dose most likely due to tolerance They will show some of the drug seeking behaviors…early refill requests, increased doctor visits, maybe start seeing other doctors due to referrals out increased anxiety/depression (often you start seeing Xanax added or antidepressants by other doctors or the same doctor–vicious cycle), But once they get re -adjusted on their pain meds and its where they are back to their ‘comfort’ level, the behaviors stop. If the pharmacist has a relationship with the patient, he/she should be asking the patient about their pain control at the time of refills, If they’re hearing about issues, a good educational proactive opportunity to encourage them keep a pain diary, use pain scales, be honest with their doctor on their pain…so many chronic pain patients have been conditioned “Not to be a bother” and ‘be stoic and suck it up’ ..As a healthcare advocate for my family members who have a chronic illness, I encourage patients to SPEAK UP with your healthcare professionals, It’s YOUR health and YOUR body, you DESERVE to be comfortable. When I work LTC, I’ve been able to correlate increased behavioral charting to increased pain or poor pain control in several of my residents, often keeping them OFF starting the psych meds. I know I’m preaching to the choir, but my 2 cents and just tossing this out there for info purposes for others.
Fast metabolizers have to do with a CP450 abnormality or some other biological quirk.. and I understand that there are now tests that will confirm such a situation.. Generally these pts need both higher doses and more frequent dosing.. A pseudo addict can be a “fast metabolizer” but can also be a pt where the prescriber does not believe the intensive of the pt’s pain and under doses or “token doses” the pt.. basically the pt is being abused by the system.. One of their options is abuse the system.. see multiple prescribers/pharmacies to get enough doses to optimize their quality of life.. NOT TO GET HIGH ! Unfortunately, there are no consequences for prescribers who refuse to properly treat chronic pain pts.. unlike the consequences for pts that try to optimize their qualify of life by “abusing the system “
I found a couple of comments interesting..1) The ‘new insurance game’? So if it’s within the week the insurance will pay but before their ’28 day fill’ policy, the pharmacy is calling for an override?? There’s a waste of time for both the pharmacy and the insurance company..You’re either comfortable with it or not. When I was asked about a few, I could look at their PMP and show where it was only a few days before the next fill date and based on their overall fill history I was comfortable with it. Most pharmacy software has a place to put notes on a fill, which came in handy because as a floater, the small independent chain I worked for was in some VERY questionable areas. I was very diligent in use of our INSPECT.
2) The Florida Legislature wants to get rid of the PDMP because of invasion of privacy issues???? I looked at their PMP website. It claims to have the patient protections in place. Law enforcement appears to have strict access to it, unless somebody has been giving them unfettered access in which case THEY have violated major privacy laws and should be held accountable. Just curious.
My heart breaks with each story of patients not being able to get their prescriptions filled. Sure call the doctor but to judge pain is between the doctor and patients. They have access to records. Have been in those shoes and they hurt.
Hey Red. I have a few questions ‘d like to ask, however keeping it brief I will ask the one question addressing a contradiction I keep noticing; the DEA claims they place no limits on qty of C2 you can order. Is that true?
Answer to this is complicated… The question “Can a pharmacy order however much of a C2 medication as they want?” is the same as the question “Can the Queen of England do whatever she wants?” The answer is “Yes, one time!”. The the England answer, if the Queen does something the people in charge “Parliament” disagree with they will strip her of all her powers and she will be nothing… If the pharmacy orders too many drugs, or has a bad ratio, or stands out in any way, even the whole seller will cut them off so they doing end up on the DEA’s radar, or the DEA will come down and demand an explanation, in detail, which will most likely end up with the pharmacy losing their DEA license.
Does the DEA limit the amount of product we can order? No, not directly, we are just running scared of them, and doing whatever we can to stay off their radar while still treating our regular patients.
Do you want to talk about mixed messages?
A doctor in the area went to the local law enforcement to state that for several months her practice manager (not a doctor) ‘forced her’ to sign prescriptions for large amounts of C2 for patients she had not personally assessed. This joker even came to her hospital bed, if she is to be believed. She finally reported herself to the law. She still has her license. No word yet about what will happen to the pharmacists that filled those prescriptions. Now she is mad because no one will fill her medication. By her own admission, some of the prescriptions she wrote are invalid, and we are supposed to trust her?!?
Dragging and screaming, the Florida Legislature passed laws to create a PDMP. It operates with no state funding whatsoever, and the law that created it states that no corporate entity can contribute money to its operation (I have no doubt that big Pharma could and would run it and actually make it work better just for the positive press). There are currently several efforts by these same legislators to repeal the law because it is an invasion of privacy. It only has funding for the next two years.
When it works, I can tell you as a WAG pharmacist when and if I can fill your medication. We try to keep to the 28-day rule for all our patients. And I say ‘try to fill your medication’ because I am required to check you out by the corporate honchos and sometimes the damn thing is on the fritz. But some insurances will actually allow a week early refill of any and all controls. Should I let it go early because the insurance will pay? On the other hand, the new insurance game is that, in order to fill your medicine, I have to call the insurance EVERY. SINGLE. TIME. for an override to state that I am ‘comfortable’ filling the script. WTF? Keep in mind that I am doing this while actually filling other prescriptions for other patients that were here before you and I will help you out. It is going to be longer than 15 minutes. And no, I don’t care if there is ice cream in the car. Don’t be an asshole because you are a pain patient. If you keep insisting that your pain trumps the little girl with an E. coli infection in her blood who can’t keep her medication down or the cute little Spanish lady with dementia who thinks I am her daughter, you are wrong. Let me work and I can help you.
Within the last three months I have personally been called by my DM for cutting my C2 order and for filling too many C2 prescriptions. My point on the first is that if I have 15 bottles of Oxy 30 in stock I really don’t need another 15. My point on the second it basically ‘What the hell?” And by C2s my DM means everything from a percocet 30 count for the man with tamsulosin and bacterium ds (kidney stone) to the nice lady crying because her RA is now so bad that she has to try morphine (15 mg, IR, 90 pills for 15 day supply because the doctor is trying to assess her threshold. Good doctor!) to my regular who has been on the same dose for years and years. This is the same DM that wants me to assess doctors based on the criteria ‘Would I send my parents to them.’ Really? How am I to make that call?
Lastly, I am apparently the only WAGs in the area tries to keep enough meds on hand for the regulars and will actually order new meds for changing therapies (if you don’t see the irony, re-read the above paragraph). It doesn’t help that my fellow stores are not keeping up with their patients and actually tell their patients that I will order medicine for them. Every time I fill for the cancer patient they don’t have enough meds for, I have to make a mental note to make sure that I will have enough for my MS patient. If you bring in a prescription for a new C2 and take the time to explain to me what is going on (I currently have 3 patients trying new therapies) and the requests are not too out of line with normal treatment guidelines (I did have one joker tell me that he was on 240 count of Oxycontin 40 mg a day in the hospital (yeah, while hooked up to a respirator maybe)), I will order for you. But I always warn people that I have been limited in the past by the damn DEA as to what I can order. I try, but sometimes my hands are tied.
If I understand your post.. your DM ( non-pharmacist ?) is interfering with you practicing pharmacy? If you are a PIC .. then when the BOP decides to take some action.. it won’t be against your DM – because he/she is not licensed by the BOP.. so they have NO AUTHORITY over him/her ! They will come after you.. because the quote from Patrick Kennedy is —we remain committed to ensuring that the practice of pharmacy in Florida is conducted in compliance with Florida law.— I take it that you have heard of “fast metabolizers” and there is even a test to determine this. I once had a end stage pt with a IV running Morphine at 20mg -30mg/Hr.. which is about twice what you claimed would cause respiratory arrest..
I don’t understand the “we try” to keep a 28 day rule… either the doc gets honest with a 30 day supply are you STICK to the 28 day rule. Create a four week calendar (Red/Yellow/Blue/Green) and you tell the pt that their fill day is one color week and one day of that week.. NO SOONER PERIOD based on the direction on the Rx. This should give the pt some extra doses to stash away to cover themselves when something goes wrong.. hurricane, tornado, ice storm, flood… whatever Mother Nature throws at them.
My father passed away from multiple myeloma. It is a heart wrenching painful disease and to watch a family member suffer with it is horrendous. You could see the tumour errosions in my fathers skull. That said , in the few months prior to his death, he managed on an average of 20mg of oxycodone total daily dose. And he was a big man over 6 foot 3. A month before his death and he was remodeling a kitchen making cabinets by hand. Three weeks before laying new sod. I realize pain is variable between individuals. I also realize that when we begin to over treat pain, eventually we come to a point where the body gets accustomed to the level of pain relief and looses the ability to create some of its own endorphins and eventually the need for a larger dose occurs. JCAHO helped create this problem with the big pain push in the 90s where everyone coming in for a stbbed toe was given vicodin. Pain needs to be treated, it doesnt mean everyone can be completely pain free. Now those who truly need it dont always have access they need and those who abuse meds just find something else to get high on. I suggest the original poster/letter writer should contact the closest Cancer Center in Fl if they live anywhere near one. They usually have an outpatient pharmacy that would be able to assist in filling opiod prescriptions for patients diagnosed with cancer.
When will they ever learn , are they going to allow us to suffer forever. This is so wrong . I am tired of hurting. God help us all.
I just rocked boat! I just emailed that jerk Exec at the BOP and really let him have it! I bet he will be shocked when reads my email. This crap has got to STOP somewhere! I am severely pissed off. I also left my signature and info on the email so I expect I will get a response from them real soon!
WTH???
First of all don’t go to Walgreens, you should know better but maybe you don’t know how cruel these snooty pharmacist are at Walgreens at the corner of unhappy and unhealthy with very angry pharmacist who think their doctors now.
So you live in Florida and have a degenerative disc disease with compression on nerve roots , neck injuries with more severe chronic pain. You should not be denied your pain meds ,file a complaint against this pharmacist and nail this witch.
With each passing story I read I get more sick what’s happening to our country making innocent people with legit chronic pain conditions suffer, its nothing more than torture.
To terrorize is to intimidate or coerce somebody with violence and harm, like this pharmacist leaving you suffering in chronic pain and not help when this pharmacist has the ability to fill your scripts for your chronic pain.
She is making you fearful or filling you with feelings of intense fear by withholding your legit /medically necessary /on time / much needed medication..
Follow the things Steve has told you to do and get this stopped, before your heart stops. Don’t let these uncompassionate pharmacist let you suffer like this. You got to move forward and fast ,the sooner you file a complaint the better.