Is This Still 1965?

Jp Enlarged

The following were in my e-mail in-box this morning. Jay Pee

Hi Jim

I was wondering if you had seen this yet?

http://www.drugstorenews.com/article/ama-adopts-resolution-pharmacist-drug-inquiries

What kind of garbage is that? Pharmacist inquiries to MDS are an “interference in the practice of medicine”?  I know this was primarily spurred by the need to reign in the overuse of narcotics, but as a technician I can see how many times the RPHs in my store have saved the doctor’s bacon. Maybe my RPHs should just fill the Ciprodex 4 gtts PO instead of calling the doc for clarification? The same with the other daily errors they catch? I mean, what’s a few injured/dead patients compared to “interfering” with the practice of medicine? (That was pure sarcasm in case you couldn’t tell.)

If you decide to put this in the blog, please don’t use my name. I work for Big Stupid and the District Pharmacy Manager already has me pegged as a bit of a troublemaker, so I don’t want to be tagged by something as idiotic as the social media policy.

Keep up the good work with the blog. I learn a lot from reading it. Documentation has been my favorite lesson so far.

…………………………………………………..

Published on Drug Topics (http://drugtopics.modernmedicine.com)


This was published in Drug Topics blog.  It bothered me because I worked for WAG and I know how careful the company is.  What got me was, again, the evidence that we, at the bottom of the funnel, are taking the heat.  What about the prescribers?  Pharmacy has been the armpit of the medical system for decades.  Now it is worse.  Pharmacy is the scapegoat.

This guy with MS, fibromyalgia (another phantom condition) and peripheral neuropathy.. does he really need oxycodone?  How about tramadol, APAP and gabapentin?  I would question this guy and I would do some serious soul-searching, just as WAG is doing.  I’d ask, “Why have you given this Bozo a free pass for so long?”

The last paragraph.  The perception that this doctor held that pharmacists were simply “prescription-fillers” really gripes me.   What is it 1965?  That is our fault.

Walgreens pharmacists denying some pain med clients

Mark Lowery, Content Editor

Publish Date: JUL 29,2013

Some customers in the Indianapolis area are furious about a new Walgreens policy that has forced some to wait up to 5 days to fill pain medications and left others feeling humiliated.

According to an investigative report by television station WTHR, shortly after the Drug Enforcement Agency (DEA) fined Walgreens $80 million for record-keeping and dispensing violations, the chain began requiring its pharmacists to call doctor’s offices to verify prescriptions and check patient’s drug histories before filling certain types of medication.

DEA cited Walgreens, the nation’s largest pharmacy chain, for unprecedented violations resulting in oxycodone and other pain medications being diverted for illegal sale on the black market. Walgreens said it has added steps to prevent illegal diversion of control substances and those steps may “take extra time.”

One customer, a man in his 30s that WTHR said was diagnosed with a combination of multiple sclerosis, fibromyalgia, and peripheral neuropathy, had filled his prescriptions without incident for 2 years at the same Walgreens location. He said he got quite a surprise when he attempted to refill his prescriptions.

“I couldn’t believe it. They actually threatened to call the cops. I’ve been a loyal customer for a long time, and all of a sudden, I was told to leave the premises or the police would be called,” the man told WTHR.

Since the man reportedly only had a 1-day supply of the Oxycontin he uses for chronic pain, he asked for his prescriptions back so he could take it to a different pharmacy.

“[The pharmacist said] ‘I’ve already started the process and now it’s out of my hands. I am not giving it back to you,’” the man told WTHR. “I felt kind of panicked and I told him, ‘I don’t think you can do that.’ That’s when he told me to leave or he’d call the police… I had no choice but to leave them there until he was able to fill them.”

The pharmacy refilled the prescription 3½ days later. “It was living hell. Living hell,” the man said. “I was in pretty bad shape and there was literally nothing I could do. I was out of medication and I couldn’t even get out of bed. I was so sick, I had to send someone else to Walgreens to pick it up for me. The whole thing is just absurd.”

Walgreens issued a statement in which it said the new policy is designed to curb prescription drug abuse. “With the sharp rise in the abuse of prescription painkillers in recent years, healthcare professionals in all practices are continuously striving to find better ways of ensuring those medications are used only for legitimate medical purposes. We are working to ensure our patients continue to have access to the medications they need while fulfilling our role in reducing the potential abuse of controlled substances,” the statement read.

“We have recently taken a number of steps to provide additional guidance and training to our pharmacies on the proper handling of controlled substances. Because of the legal requirements placed on pharmacists to verify that controlled substance prescriptions are issued for a legitimate medical purpose, pharmacists may need to gather additional patient information from their prescribing physician’s office. This diligence may take extra time.”

Another Walgreens customer said she was told to take her business elsewhere when she attempted to refill her pain-medication prescription. “They refused [to fill] it. [The pharmacist said] ‘We suggest you take it to CVS. At this point we’re just feeding an addiction.’ He was very loud and it was right in the open when he basically called me an addict,” she told WTHR. “At that point, I was just so upset I left.”

Some doctors are also complaining about delays caused by Walgreens new policy. “The pharmacy will call and further investigate. They’ll say ‘Why is this patient getting this script? What’s wrong with them? What’s the diagnosis? How long are they going to be on it? How long have they been on it?’” Ed Kowlowitz, medical director, Center for Pain Management in Indianapolis, told WTHR. “They’re not just filling scripts anymore.”

 

5 Comments

5 Comments

  1. Pharmaciststeve  •  Aug 3, 2013 @2:12 pm

    Let’s start with the fact that pain is SUBJECTIVE.. just like thirst, hunger, sleepiness .. I dare anyone to claim that they know how a person’s subjective feelings of the above is by talking or looking at them.

    I suppose that everyone eat, drinks, sleep the exact same amount each day at the same time !.. YET we expect people with chronic pain to take the same medication – quantity and strength… every so many hours..

    Ask any chronic pain pt and they will tell you that their pain varies minute to minute.. hour to hour.. day to day..

    How ludicrous is it to give someone a hypnotic at bedtime because their pain will not let them sleep or give them a 3-4 hr dose.. expecting it to last 6-8 hrs..

    IMO… Tramadol is about as useful as Darvon/Darvocet in treating chronic pain above 4 on the scale.

    IMO.. the bureaucrats do not want to do much about drug abuse.. it is a good reason to want larger budgets, more people and more power..

    I wonder how many bogus ID’s are given to RPh’s when they fill controls.. and in doing so. they put bogus information in the state’s PMP.. If they can forge credit cards and other things.. they can forge driver licenses.. if man can create it… man – or a kid – can forge it.

    Did you ever notice that it transparent to submit data to the state’s PMP .. but.. trying to get a report back.. takes too much time.. is this done to discourage running reports? Why can’t the same process that submits data.. retrieve data… nearly transparently..

    As a final note – IMO – anyone who believes that Fibromyalgia is a “phantom condition” is either clueless or is still living in the 60′s.. when it was called “whining woman’s disease”.

    I personally know several female Pharmacists that have first hand experience with this disease and I don’ think that they would consider it a phantom disease.

    Okay, Steve. I will defer to your experience and knowledge in the realm of Pain Control and readily admit that my comments were inflammatory and meant to get a response. However, you gotta consider that there are “smart rat” drug seekers out there who claim to have pain conditions that have no methods for objective diagnosis. No tests. No anything other than the patient’s word. A smart rat will learn the symptoms and use their acting skills. A really smart rat will report the symptoms and get the doctor to make the diagnosis the rat wants.

    During the very early 1970s, I counseled a number of young men with low draft lottery numbers. They were destined to be sent to a jungle in Southeast Asia. “What can I do, Jim? I can’t go there and I don’t want to kill or be killed.” was the classic lament. About a half dozen early twenty-somethings. I suggested that they study the symptoms of debilitating migraines and to read as many case studies as they could find. Not that easy before the Internet. All of them took my advice. All of them saw a doctor who was sold on their migraines. All of them got prescriptions for migraine medicines. All of them had them filled and refilled. All of them were classified 1-Y and were not drafted.

    I object strongly to the DEA targeting pharmacists/pharmacies in their attempt to get control. Why do the prescribers get a
    free pass? Doctors have been having their dicks rubbed by our culture for a century and more. It pisses me off when they are just practitioners. Some of them really competent and superstars. Many of them lousy.

  2. Steve Leuck  •  Aug 3, 2013 @2:24 pm

    The statement that the AMA made in June of this year goes directly against the spirit of health-care-team collaboration. The medical team has grown into a patient centered effort to help assure that the most appropriate care is granted to the patient at all points of treatment. All members of the health care team need to be on the same page with regards to treatment, while at the same time, all team members must be in a position where they may question the other team members regarding current treatment plan efforts.

    I understand that this statement may have something to do with the recent controlled substance case in Florida where one of the chain store pharmacies’ agreed to pay a fine of $80 million dollars for allowing millions of controlled substances to reach the black market. The American Society of Health system Pharmacists did their best effort at trying to explain what was at the root of the statement.

    ”Certain pharmacies, in response to enhanced scrutiny and enforcement efforts by the Drug Enforcement Administration, are calling and faxing to verify the legitimacy of every controlled substance prescription before filling. The burden this has caused some physicians’ offices gave rise to this new AMA policy”.

    I appreciate the effort that ASHP is putting into the clarification of the statement made by the AMA; however, I feel it would be much more appropriate if the AMA were to come out and clarify this statement. As far as I can see, after reading the resolved statement, the AMA is stating that pharmacist calls to physicians regarding therapy are an intrusion into appropriate medical care and need to be stopped. The AMA statement does not state anything about phone calls relating to narcotic related diagnosis questions.

    I agree that the faxing and telephoning of physicians’ offices by some pharmacies to verify the legitimacy of each and every controlled substance prescription is absurdly redundant and can be handled much more appropriately with Due Diligence by a professional pharmacist doing their job in the pharmacy. I must also point out that the AMA stating that pharmacists phone calls are an intrusion into medical practice is no way to promote collaboration as a health care team.

  3. wellilbe  •  Aug 3, 2013 @7:28 pm

    I personally believe, JCAHO policies and requirements in the 90s started feeding our current addiction problem. They demanded policies be in place to ensure adequate pain management. Nice in theory. However, by going overboard to satisfy the requirements of JCAHO to ensure a pain level of well almost zero was ridiculous/ People were meant to have SOME pain as a safety mechanisim to ensure they weren’t endangering themselves. As in, “Hey dipshit! You just had surgery, how about you not move around so much and I won’t send pain signals to punish you?” Patients who normally wouldn’t have been given pain meds for more than a day or two post surgery began receiving them for weeks afterward. Just my opinion. As well, as far as I am concerned the jury is still out on fibromyalgia.. That said. I must agree with Pharmacist Steve that patients who are legitimately on pain medication are being denoed pain relief because the DEA is to weak to go after the erroneous prescribers and instead are making the pharmacists do their dirty work. Make a database, require entry by the MD at time of ordering, with the rx being directly sent electronically to the pharmacy. The patients license number should be attached( or valid passport number) to the electronic rx. If another md tries to order for the same pt a red flag comes up and the onus is on him!!

  4. Jeremy  •  Aug 6, 2013 @5:26 pm

    what the pharmacy associations and pharmacists should have said in response is “no, we are not practicing medicine without a license when we call to verify these prescriptions, we are doing the DEA’s job for them by investigating your prescribing habits” then we could give them a one arm (bent and fisted) over the other arm gesture.

  5. Pharmaciststeve  •  Oct 29, 2013 @7:48 pm

    Have wholesalers overstepped their authority ?
    http://www.pharmaciststeve.com/?p=4523

Leave a Reply

Allowed tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>