Frank Schiraldi is a 59 year old Pennsylvania pharmacist working in managed care at a PBM. He developed pancreatitis in 2011. He since had a diagnosis of chronic pancreatitis, groove pancreatitis, avoided a Whipple Surgery, and did have Celiac Plexus nerve block. He recently learned he also has generalized Myasthenia Gravis, not yet controlled. He wrote President Obama the following letter:
As a pharmacist practicing in managed care at a PBM, I am front and center of the opioid prescription crisis we face today. There is no doubt that these powerful drugs are over-prescribed and causing harm.
But – though drastic action was needed to rein this in, I’m afraid that invoking a second (or third) prohibition will have a far worse outcome, both short and long-term. Every position piece and policy directive I’ve read – as well as the many coverage pieces from major press outlets, have been entirely focused on abuse and addiction topics. At most, I’ve only seen an occasional footnote about the real chronic pain patients benefiting from these medications today. Little if nothing is said about how we are going to be able to continue their much needed care.
Based on the draft guidelines I read from the CDC, no provision is being made for long-term treatment for true chronic pain patients. In real practice, I am seeing the impact first-hand. This has turned out to be a slash campaign, where doctors are not treating in pure fear of DEA actions, and patients are getting hurt, and are worse off because of it.
If this is to follow in the overall directive of “Patient Outcomes” – we must realize that not every prescription for an opiate drug is being abused. These prescriptions are falling into two separate buckets of consumers. Those who are abusing the drugs, and those who are benefiting from chronic pain treatment. The two pathways are clear – addiction treatment, and pain management. Right now, “all the noise” and press is about cleaning up the streets. There has been ZERO communication about the safe continuation of medically valid pain management. People are people – they just don’t know what to do! Sure, we don’t want to expose any pathways to all the bad actors, but all the doctors and pharmacists are so damn scared of the DEA, they are afraid of helping the remaining patients who need it.
Perhaps the DEA is a bit over-zealous in carrying out your directive on prescription drug abuse. I’m not a fan of draconian measures. I’m also professionally concerned when we harm the patient. The numbers being harmed are enormous, far greater than many expected.
The biggest red flag in all of this should be how little you are hearing this feedback – from patients, from doctors, nurses, or pharmacists. All scared for their own reasons.
Let’s step back, take a breath, and re-evaluate this, and quickly. Yes, people are dying. If you want to talk more, there are thousands of us ready to chat.