The U.S. Drug Enforcement Administration has expanded the war on pain patients from the shores of Florida to the shores of California — with a tsunami of confusion, pain and the inevitable deaths from their repressive policies.
Recently, the New York Times published an article on the DEA’s efforts to reduce the supply of opioid analgesics by bringing pressure on large pharmaceutical distributors. The agency, using heavy-handed tactics, is also targeting pharmacies they deem to have sold more analgesics than the DEA feels is appropriate.
The focus of the Times article was Mike Pavlovich, an award-winning pharmacist and owner of the Westcliff Pharmacy in Newport Beach, California. It was only after Pavlovich did not receive his usual shipment of opioid medicines from his distributor that he discovered the distinctive footprint of the DEA.
After making several inquiries, Pavlovich learned that the DEA had accused Cardinal Health, his distributor, of supplying too many opioids to Florida pharmacies and not having adequate controls to detect diversion. After being heavily fined, Cardinal Health started checking the records of its pharmacy customers in other parts of the country. The number of prescriptions Pavlovich was filling for opioids and other controlled substances was too high for their comfort level.
There’s a good reason for all those prescriptions. Pavlovich is a trusted pharmacist who works with doctors who specialize in treating patients who suffer from chronic, debilitating pain. He was the only pharmacist on the U.S. Olympic Committee’s medical team to travel to China for the Beijing Olympics in 2008. He’s also a mentor and has tried to educate others on the safe filling of opioid prescriptions.
Pavlovich says he has never been cited by the State Board of Pharmacy or the DEA for any transgressions. He was not running a west coast version of an east coast pill mill.
In a phone interview Pavlovich told me how careful he is when filling opioid prescriptions. He regularly checks California’s prescription drug monitoring program, which alerts pharmacists to a patient abusing the system. If he has any doubts about a prescription or a patient, he investigates further.
Pavlovich discovered that no other large distributor would fill his entire prescription order. The DEA had cast a wide net. After further discussions he was able to secure only 15% of his oxycodone order from Cardinal Health. Other opiates are still available.
By putting the squeeze on his distributor, the DEA’s actions have affected Pavlovich in two detrimental ways.
First, the sudden reduction in his drug stock could cripple his business. He’s not only concerned about his own family but also the families of his employees.
Second, Pavlovich fears for patients who rely on opioids for pain control. Because of the reduced supply of opioids he’s been unable to fill prescriptions for many of his customers. He has to turn away two or three of them daily.
Pavlovich is well aware of the misery that this crackdown is having on pain patients. For those who come to him when they are nearly out of their prescriptions, he and other pharmacists have little relief or hope to offer.
“DEA’s recent policy enforcement has made it virtually impossible for a pharmacy that serves patients with chronic pain as their primary niche to meet the needs of its patients,” says Pavlovich.
In his conversations with the DEA Pavlovich has tried to pin down exactly what the agency considers as excessive sales of opioids. It seems that regulators have come up with a slippery equation to determine how much a pharmacy can obtain from its distributors.
According to Pavlovich, the formula works something like this: If a pharmacy sells one hundred units or products; then that store will only be able to sell opioids anywhere from 15% to 40% of the total sales volume.
To meet that threshold, Pavlovich says he’ll have to increase his sales of other medicines and goods to expand his opioid supply.
All of this is a guessing game, however. Without a clear policy from the DEA, Pavlovich and other pharmacists are left in limbo, along with their suffering customers.
This has the proven potential of consigning these patients into the agony of withdrawal. As I’ve written in previous columns, this repression of a powerless class of citizens can and will have deadly effects on people with chronic pain.
Pavlovich points to the rising use of heroin and other street drugs. It is no wonder to him and to others that this is the direct result of restricting lawful opioid analgesics for legitimate pain patients.
We will witness a rise in overdoses and deaths. And it is likely that there will also be a spike in suicides among desperate pain patients unable to find relief from scalding torture.
The DEA is using a meat cleaver when a scalpel would do. To simply cut off pharmacies without first determining the nature of the customers being served suggests something more sinister.
Yes, the public needs protection, but no less than legitimate patients.
I believe that the repressive organs of our government ultimately want to make these lifesaving medicines available only for cancer patients and those with terminal diseases; other pain patients be damned.
I urge patients turned away from their pharmacies to tell your personal stories to your Congressional representatives. If you can, go to their offices and speak with the aides who follow health care issues. If not, a letter, email or call will do. .
We need to create our own tsunami to sweep away these egregious policies.
Damned I won’t be.
Neither should you.
Mark Maginn lives in the east bay of San Francisco where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog can be found here.
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