One month after hydrocodone was rescheduled by the U.S. Drug Enforcement Administration, pain patients in some parts of the country say pharmacists are refusing to fill their prescriptions or claiming the medication is out of stock.
Some patients — who’ve been on hydrocodone for years and have legitimate prescriptions — are going into withdrawal without the opioid pain medicine. Others are considering suicide.
“Nobody will fill it. Nobody has it,” says Janice Power, a 54-year old chronic pain sufferer in Sun City, Florida who’s been on hydrocodone for 9 years.
“I have enough to hold me over for one week. Something needs to happen urgently or many disabled and suffering patients will indeed be dead.”
In an effort to combat a nationwide “epidemic” of prescription drug abuse, hydrocodone combination products were rescheduled by the DEA on October 6th from a Schedule III narcotic to a more restrictive Schedule II.
The rescheduling limits patients to an initial 90-day supply and requires them to see a doctor for a new prescription each time they need a refill. Prescriptions for Schedule II drugs also cannot be phoned or faxed in by physicians.
The changes may sound simple and reasonable, but many patients and pain management experts say some health care providers, particularly pharmacists, have overreacted to the DEA’s rescheduling. A drug that was once the most widely prescribed medication in the country – with nearly 130 million prescriptions being written annually – is now in short supply or simply unavailable in some areas.
“There’s far less being prescribed. A lot of doctors are afraid to prescribe. Pharmacists don’t want to fill the prescriptions,” said Lynn Webster, MD, past president of the American Academy of Pain Medicine.
“I’ve had a number a people send me obituaries for people who have not been able to access their medications and decided to kill themselves. So this is not a trivial issue. There are unintended consequences that are occurring. No one wants anybody to commit suicide and no one wants more suffering, but that is occurring.”
Janice Power isn’t suffering yet, but is worried what she will do if she can’t find a pharmacist to refill her prescription for Vicodin, perhaps the most well-known hydrocodone product.
“It’s a shock when you wake up and you go to the pharmacy and they say, ‘We can’t get this for you anymore.’ How can a government just cold turkey make everybody stop taking a drug that’s they’ve been on for so long? It’s going to make a lot of people sick,” Power told National Pain Report.
“There are patients with cancer and chemo who are going through this also, not just me. As a human being, I have rights. If they want to do this, then make suicides legal so we have the choice to die in dignity.”
Another pain patient in Texas said she had no trouble getting refills of hydrocodone at a CVS drug store until recently.
“I went back and they said nope, we’ve got a new policy and we won’t fill these prescriptions at all,” said Lori, a 55-year old patient who’s been taking hydrocodone for 10 years. She asked that we not use her last name.
“I went everywhere, two or three different ones (CVS pharmacies). They all had a different story. We’re either out of stock or we don’t fill Schedule II narcotics. There were people in front of me in line that they would tell, ‘We can no longer feed your addiction.’ There was an old lady with a walker who looked pretty disabled, they would get hers. But there were others of us who wouldn’t get it. So there was profiling that was going on by the pharmacists.
“You can see people standing in line in withdrawal. It’s so pitiful. There are elderly people coming in, being denied. You can tell they’re withdrawing off medication and they shouldn’t be.”
Lori eventually managed to get her prescription filled at a Walgreens, but is not sure they’ll do it again.
“If I have to withdraw from it cold turkey, I could die. That’s my real concern,” she said.
“We have gotten an uptick in calls from patients who haven’t been able to get their prescriptions filled,” said Bob Twillman, PhD, Deputy Executive Director of Policy and Advocacy for the American Academy of Pain Management.
Twillman believes the shortage of hydrocodone may be short-lived.
“It might be temporary. I hope that’s the case,” he told National Pain Report. “One of the things that happened when it was rescheduled is that everything within the distribution chain that had not yet made it to the retail pharmacy, everything that was in that space that had a C-III (Schedule III) label had to go back to the manufacturer and be relabeled as a C-II (Schedule II) before it could go back to the pharmacy.”
But a DEA spokesman says there was ample time for drug wholesalers and retailers to adjust to the rescheduling. The DEA published an order rescheduling hydrocodone in the Federal Register in August, 45 days before the order took effect. The Food and Drug Administration agreed to the rescheduling in 2013, after years of resisting it.
“When somebody goes to a pharmacy with a prescription and the pharmacist tells them we don’t have this or I can’t fill this, they typically blame the DEA. For whatever reason, people are being turned away. And I don’t know the answer for that or know why,” said DEA spokesman Rusty Payne.
Payne says some major pharmacies may have made a “business decision” not to fill as many prescriptions for hydrocodone, after being fined tens of millions of dollars for violating rules and regulations for dispensing controlled substances.
“The only thing I can tell you is that a lot of the companies are over-correcting the other way, CVS, Walgreens, whoever. It’s very possible they are just afraid or they are just not purchasing as much, so they won’t have as much in stock. I don’t know.”
A spokesman for CVS Pharmacy blamed “regulatory controls” for any possible shortages.
“Regulatory controls on certain medications may limit the inventory level of these controlled substances in a pharmacy. We recommend that patients call their pharmacy a few days before their prescription is due to be refilled to determine if there is adequate supply of the medication. Should there be a supply issue, our pharmacist will work with the patient to try and find available medication at another nearby pharmacy,” said Michael DeAngelis in a statement to National Pain Report.
No matter who is at fault for the alleged shortages of hydrocodone and for prescriptions not being filled – pain patients are caught in middle and left wondering if they will cutoff next.
“It reminds me of Nazi Germany. It’s like a death panel,” says Lori, who dismisses the idea that she should switch to some other painkiller. “We have tried every drug on the market. I have intractable pain. It will never go away. People have intractable pain that can’t be treated and I’m one of them.
“Think of all the diabetics in this nation. We could say, ‘You’re a bunch of fat sugar addicts. You’re not getting your insulin this week because you need to stop eating crap and exercise.’ That’s what they’re saying to us. They’re saying, ‘Okay all you pain addicts, you don’t need all these pain pills, withdraw from them.’ They don’t even consider these very serious medical conditions.”