The state of Florida recently endured a terrible epidemic; prescription drug abuse. Approximately 7 persons died daily in our state from prescription drug overdoses. This was fueled by the proliferation of “pill mills” that dispensed millions of units of oxycodone, carisoprodol, and alprazolam.
Pharmacies were also involved the dispensing of these drugs. Walgreens and CVS Pharmacy were fined tens of millions of dollars by the Drug Enforcement Administration (DEA) for violating rules and regulations for dispensing controlled substances.
Now both Walgreens and CVS have developed checklists and internal policies which have resulted in severely limited access for legitimate pain patients. Many patients must negotiate of gauntlet of checklists and rules to obtain their pain medications.
Physicians have been contacted by pharmacists who request diagnoses, MRI’s, treatment history, and other patient protected information for (which they do not have the medical training to interpret) prior to filling their prescriptions. This has resulted in frustration and complaints by and for patients who are now unable to obtain legitimate prescriptions for legitimate painful medical conditions.
The pharmacists cite the DEA doctrine of “Corresponding Responsibility” that states: “A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent of section 309 of the Act (21 U.S.C. 829) and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances.”
Pharmacies have now made it almost impossible for a patient to obtain a controlled substance. They are overreacting in fear of losing their licenses.
The Florida Medical Association recently passed a resolution to address this problem. We recently created a task force which held a conference with representatives from the Pharmacy Retail Association, DEA, the Florida Society of Interventional Pain Physicians, The Florida Academy of Pain Medicine and the Florida Society of Physical Medicine and Rehabilitation.
There is much to address and the problem is getting worse. Pharmacies blame the DEA; the DEA blames pharmacies. Doctors and their patients are trapped in the middle.
Walgreens has a corporate policy that specifically requests patient sensitive information from physicians prior to filling a controlled medication. Imagine if you a physician who may write 10 or 20 of these prescriptions daily for legitimate medical purposes. Your practice grinds to a halt with the barrage of phone calls and faxes from Walgreens demanding information. If what you provide does not pass muster, then your patient does not get their medications. This could lead to withdrawal, misery and perhaps worse.
Pharmacies have taken the wrong approach. They have put their own interests (as corporations often do) ahead of the patients they claim to treat. Pharmacies now administer vaccinations, have walk-in- clinics and provide medical advice to patients. CVS finally removed all tobacco products from its stores. Now they seek to make decisions based on medical necessity, of which they are not qualified to do, which destroys the doctor-patient relationship.
Those of us who fought to create legislation to eliminate pill mills and reduce the deaths in Florida knew that there would be some fallout. However, we never anticipated that this would happen.
Pharmacies are consumer oriented. Perhaps patients should reconsider where they fill their prescriptions and do their shopping. They do have a choice. As a pain specialist, I can tell you that the current situation is not sustainable. Pain physicians cannot operate with such obstacles that are unnecessary and unwarranted. Patients will suffer and pharmacies may pay the price.
Sanford M. Silverman, MD, is in private practice as the medical director and CEO of Comprehensive Pain Medicine in Pompano Beach, FL. He is board certified in anesthesiology with added qualifications in pain management from the American Board of Anesthesiology and a Diplomate in Pain Medicine from the American Board of Pain Medicine. Dr Silverman is also a Diplomate in Addiction Medicine from the American Board of Addiction Medicine. He is currently the president of the Broward County Medical Society and immediate past President of the Florida Society of Interventional Pain Physicians.