March 12th, 2014 by Pat Anson, Editor
Pharmacists and patient advocates say the results of a survey by the National Pain Foundation show that a crackdown on prescription painkillers by the Drug Enforcement Administration is causing fear and confusion in the pain community.
In the survey of over 300 pain patients, over half (52%) said that they are worried that “I may be viewed as a drug addict” and 29% were concerned that they might be “embarrassed” by their pharmacist while trying to get a prescription filled. Many patients also complained they were unfairly denied pain medication by a pharmacist.
“These survey results are not really surprising considering the DEA’s aggressive efforts attempting to stem the tide of prescription drug abuse,” the National Community Pharmacists Association (NCPA) said in a statement to National Pain Report.
“Their crackdown efforts, while well intentioned, have put medication wholesalers into a defensive crouch where pharmacies that don’t fit into the standard dispensing patterns for controlled substances, such as pharmacies serving hospice patients or located near a surgery center, could have their supplies limited or cut off, thus greatly affecting patients with legitimate pain issues.”
NCPA represents over 23,000 independent pharmacies across the U.S. In January, NCPA said many of its members had their shipments of controlled substances abruptly cut off by drug wholesalers, which it blamed on the “perceived pressure, intimidation or a lack of clear guidance” from the Drug Enforcement Administration.
“We believe the root cause of the prescription drug abuse crisis is a small handful of prescribers writing hundreds or even thousands of prescriptions that find their way into the hands of substance abusers,” NCPA said in its statement.
“As the DEA further refines their policies much of the apprehension that some patients feel will hopefully be addressed, and be replaced with the positive attitude that most patients have towards pharmacists, especially independent community pharmacists at whose pharmacies patients are a name and not a number.”
While the survey by the National Pain Foundation did find that many patients were worried about how they were perceived by pharmacists, nearly two-thirds (62%) said they were treated “well” or “very well” by their pharmacist.
“I think that it would be interesting if these patients that are happy with their pharmacist to determine if there was a higher level of satisfaction with independent pharmacies over chains. The chain pharmacists get paid if they fill zero controls (controlled substance prescriptions) or 100 controls. Not so much for the independently owned pharmacy,” says Steve Ariens, a retired pharmacist and patient advocate who has a blog called Pharmacist Steve.
“I am aware of three pharmacies, one in Arizona and two in California, that had a lot of chronic pain patients in their practice and they were both completely cut off from getting opiates from their wholesalers because the wholesalers were told by the DEA that they had to establish some arbitrary limits of ratio of controls to the rest of their purchases,” Ariens said in an email to National Pain Report.
“My understanding is that other pharmacies when their shipments hit this arbitrary monthly limit they are just cut off for the rest of the month. Patients that need their medication after that point are out of luck.”
The DEA has denied trying to limit or ration access to opioid painkillers. A DEA spokesman told National Pain Report “nothing should stand in the way” of a patient getting a legitimate prescription for pain medication filled.
“We do look at distributors and what they’re selling. And typically what we look for are patterns, like abrupt changes. So if we see that a distributor sells “X” amount that’s pretty steady and then all of sudden there’s a significant spike, we might want to ask questions why,” said DEA spokesman Rusty Payne.
“We look for patterns. We take action on egregious violations. And CVS and Walgreens would be good examples of that,” said Payne, referring to enforcement actions taken against the drug store chains, which were fined tens of millions of dollars for violating rules and regulations for dispensing controlled substances.
The Los Angeles Times reported this week that CVS pharmacies could face additional fines for allegedly losing track of 37,000 prescription painkillers at four of its California stores. Many may have been sold on the black market.
In addition to their fear of being perceived as drug addicts, the National Pain Foundation survey also revealed that many pain patients go from doctor to doctor before finally finding one to treat their pain.
A large majority (82%) said they had stopped seeing a doctor because they were treated poorly. Many patients (71%) had seen four or more physicians to treat their pain and 20% had gone to ten or more doctors.
Only about half (53%) said they were treated “well” or “very well” by their current pain physician during appointments.
“What I personally get from these results is the proof of why we, as patients must stop adding our emotions and fears into the mix. They are being used against us as a way of focusing the blame on us and keep the ‘old school’ doctors hanging around longer,” said Dennis Kinch, a patient advocate and chronic pain sufferer.
“These results show the patient fears and perceptions of care contrasted with the actualities of treatment. It also shows a large inconsistency in the professional ranks with over 80% of patients changing doctors due to poor treatment, yet better than half finding good treatment with the next doctor, or at least the third. How much of this is a personality clash or the doctor thinking poorly of the patient and treating them thus, the survey doesn’t tell. In my experience it is the latter.”
