Pharmacists Blame Patient Fears on DEA

Pharmacists Blame Patient Fears on DEA

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 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.

American pharmacist with senior woman in pharmacy“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.”

NationalPain&Report_logosWhile 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.

CVSin_Tequesta“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.”

Authored by: Pat Anson, Editor

There are 15 comments for this article
  1. patti at 3:28 am

    I could care less about what people may think or say because I need and take pain medications or opiates, narcotics, drugs or whatever they want to call it. What I care about is being able to get my medications and continue on the dosage level I have been on for many years. After living with severe intractable pain due to Interstitial Cystitis for 22 years causing severe pelvic pain day in and day out; combined with sciatica and back, hip, leg pain ruptured L5/6 I just want to keep my pain from taking over every waking moment. Truth be told I am terrified because if politicians like Governor Hickenlooper of Colorado gets his way (without acknowledging or meeting with the chronic pain patients) he might as well take us all out in back of his mansion and shoot us in the head; because under the bill he is trying to get passed we would all be having our medication quantities cut back and not allowed to take pain medications and muscle relaxants at the same time. He uses stats to prove his case but they are very skewed because it does not include those of us that benefit from opiates by going back to work, taking care of our children and achieving an improved quality of life that most people that are pain free take for granted. Due to methadone I was able to continue my career for over 20 years while in pain. If Governor gets his way I will go back to the beginning which was pure hell. I don’t care how the pharmacists treat me or what they think I only care that my prescription is filled. I am on my 4th pharmacy in 3 years due to dosages that Walgreens, then King Soopers and several local & even the hospital pharmacies state they are not comfortable in filling them. They filled them for years and now all of a sudden NOPE. What will the governors and government entities due when chronic pain patients start dying from suicide because they can no longer live with their pain. I am increasingly in a constant state of panic because of what these politicians and government entities can do to ruin my life because they are only concerned about the abuse not about those that benefit from pain management and follow the rules.

    Why not take alcohol off the market it causes millions of deaths: suicides; drunk driving; liver failure; cancer; domestic violence and although not publicized it frequently contributes to the deaths blamed solely on opiates medications. I am not sure where or how to start but It is imperative that those of us with Chronic/intractable pain unite and fight for our rights. We represent over 75 million American citizens that pay taxes and vote. Although it is difficult for many of us to be physically active; stand up to protest or even sit and type letters, but for those of us that can we must all do what we can or have a loved one or friend help us; otherwise the FDA, DEA, DORA & Politicians wanting recognition for stopping drugs will strip us of our rights to life, liberty and the pursuit of happiness.

  2. Myron Shank, M.D., Ph.D. at 10:26 am

    @Mike Fogarty:

    Fundamentally, this is a political problem. Board members are appointed by the governor without any sort of approval or review by those who are actually qualified to evaluate the appointees. Adding to the absurdity, at least in Ohio, people are selected to serve and as members of the Board precisely BECAUSE they are medically UNqualified, and each of their votes count as much as those of a member who might (hypothetically, but, unfortunately, not in reality) be the world’s foremost authority on pain management and opioid use.

    I would not go so far as to suggest that Ohio physicians are intrinsically different than other physicians, but I would concede that your formerly Ohio physician may very well illustrate the problem of “contagion” in ideas. This is well-explained by the phenomenon of “cognitive dissonance.” In other words, if one lives in a world where consequences are inconsistent with one’s beliefs, it is a lot easier to change one’s beliefs than to either accept the discrepancy or change one’s world.

    I may not have much control over my world, but such as I have, I will continue to exert. When my life is done, at least I will be able to say that I remained true to what was right, no matter how costly it was to do so.

  3. Mike Fogarty at 8:31 am

    Dr. Shank, I’m sorry to hear you got caught up in the witch hunt. Oddly enough, the current chair of our Board of Medicine here in Florida is a doctor from Ohio. He is a rabid opiophobe, and viciously persecutes pain doctors.

  4. Myron Shank, M.D., Ph.D. at 5:59 pm

    @Mike Fogarty: I am glad that you mentioned the duration of action of controlled release oxycodone (Oxycontin). The FDA’s own data shows that it should be a six to eight hour drug, Even though I was certified as an expert in pain management, the State Medical Board of Ohio and its witness (whom the State repeatedly stipulated was NOT an expert in anything) pointed to my justification for more frequent dosing of lower doses with detailed justification for this with the FDA’s own data as proof that I was “overprescribing” Ignoring the abundant medical and regulatory literature against the concept of “overprescribing” opioids, when they are titrated to pain and functional status, how is a given quantity of opioids “overprescribed” when administered in smaller, more frequent, doses?

    The question answers itself. The State Medical Board of Ohio has an agenda that is at odds not only with the medical literature, the guideline and recommendations of nationally recognized authorities, and even its own rules and regulations and the laws of the State of Ohio.

    Regretably, while not as blatantly egregious, most, if not all, other state medical boards appear to believe that “all’s fair in” their “war on drugs.”

  5. Dave at 9:01 am

    Carolyn- You know what you are up against and it seems like you are assertive, as well. Kudos for being a “pain survivor”.
    You are nobler than the forces against you and you can overcome all the mindless monkey business.
    I hope one fine day you will be pain free and will eventually lose the memory of pain- it happened to me- despite my disbelief- but who knows what the future may hold!

  6. Mike Fogarty at 6:51 am

    The small Pharmacy I use has flat out told me any time their order for Controlled substances exceeds 20% they are cut off by the wholesaler because they know they will be targeted by DEA. What is becoming more of a problem is the graduated series of letters from FDA regarding “Voluntary” REMS education. The clear impression for Doctors and Pharmacists is that any deviation from label instructions will be scrutinized and prosecuted. It was discovered years ago that medications like Oxycontin were most effectively dosed three times a day, but since the label says twice a day, many of us have been cut back to that by doctors being afraid to prescribe and pharmacists refusing to fill.

  7. Donna at 6:27 am

    One of the main problems that we are facing in Florida according to my last primary doctor is: that the FDA will not allow a MD to write prescriptions for narcotics or opiates” Only Pain Management Doctors can. So I now see a pain management doctor who is very knowledgable of all the “Invisible Illnesses” I have, he has never belittled me or made me think it was all in my head. He has tried Trigger Point Injections (which for me made the pain much worse), he’s tried a tens unit, physical therapy and Cervical Epidurals. The Cervical Epidurals work best for me I have had them done 3 times since August 2013, however they are not lasting as long as the first one did. He has also referred me to a Neurologist to have a nerve conductor test done on my left arm and shoulder. He listens to me and answers all my questions but now he’s not sure of what else he can do to continue to give me pain relief. I also use an ER Butrans Patch for 7 days, and I have Percoset 10/325 I can use for break through. The percosets do not in any way take the pain away but does take the edge off. But now the pain has been getting so much worse and I don’t understand why. I will be seeing him next week and we are going to discuss a new plan of action. I have no problems with my pharmacy. I have been using the same pharmacy for about 15 years. The pharmacy always have to order the pain medications for me but always have them in by the next morning. Kudo’s to Winn Dixie. I have friends who use small pharmacies that are privately owned and they can no longer get some of the medications she has been getting for years. She started using a company owned Pharmacy and on one of her prescriptions they didn’t have the whole 90 pills needed to fill her script. They told her she had to take the 50 they had in stock but could not get the remaining 40 when their next order came in. So she had to do without the full script. I told her to contact her dr. and go to the manager of the pharmacy but she never did. This could be one way that people on the streets are getting drugs. Somebody is going to take the other 40 pills she didn’t get( This is my opinion only)

  8. Carolyn at 11:08 pm

    Dave … lol. So what you’re saying is that the Canadian system is fast becoming as bad as the US? 🙂 Yes .. well perhaps so. But when you live in a small community, facing people off can work. If it’s only one pharmacist who fills my prescriptions without the projected fear attitude, knowing who I am just enough and vice versa … Unfortunately, this isn’t the norm for most. I have experienced the unprofessional, hysterical, mindless behaviors of ignorant self serving doctors and pharmacists alike … I still have to deal with a doctor who thinks he’s god and it’s time consuming to have to smack him and bring him back to earth. As for understanding … ha! What can be very upsetting for a chronic pain patient, is to be around people who say they understand, yet continue to attempt to apply the normal time frames to your clearly much altered lifestyle, where it takes you 2-3 hours to get ready for the day … where mornings are the worst time .. if you work more than 2 hours physically, you have to go to bed to sleep for 4-5 hours.
    Yessir bob … erm .. Dave .. it’s a scary ole world out there at the best of times … more so for us … all this fear mongering is dangerous. While the politicos and the wealthy who are profiting from our pain …

  9. dave at 8:05 pm

    Carolyn- C’mon now- you know the experts believe that pain isnt important- for no one dies of pain and that people in pain are just a bunch of bellyaching catastrophizers- unless they have a serious condition like cancer. But “suicidal pain” like thunderclap headaches or trigeminal neuralgia or life ruining painful conditions-there not important enough to ensure the right to adequate treatment.
    Don’t you realize people in pain are supposed to serve the needs of government and the health care industry and not vice versa? Don’t you have empathy for the politician needing money from medical organizations to pay for their reelection campaigns? Don’t you care about helping doctors pay for medical school or being paid twice as much as European doctors? How selfish you are to expect pharmacies and medicine to care about your pain and treat you with compassion and ethically. Just do what they say and never complain no matter how poorly they treat you-after all they are better than people in pain who catastrophize all the time.
    We should be happy to have a pain care system that is as Narcissistic as it is and costing more and more money all the time and failing to lower the prevalence of any painful condition- after all- that is the American way!

  10. Carolyn at 9:48 pm

    It’s become as bad in Canada, though to my knowledge, the harassment and fear mongering is coming from the Colleges of Physicians, and from irresponsible media. I’ve been through a harrowing situation with my doctor, who lies to me, lies to my pharmacist … the bottom line being my doctor doesn’t like prescribing opiates. Too bad for him. He was told clearly before taking me on what my needs were. I agreed to sign the contract .. yet he continues to cause me problems, worse that he does it when I have run out of my medications. Due to the lack of doctors taking new patients, and again made worse if you are on narcotic pain medications as doctors are now refusing to even take you on if that is the case. I think that should be illegal. Doctors are paid by the taxpayer. Somehow or other they now appear to have gained such power as to dictate to us how they will care for us. I agree about the fear of being shamed, whether by one’s doctor or their pharmacist, the latter being who treated me like scum, as did his other staff. It took me going in, and having a face to face meeting with him and straightening him out on the facts of my situation. It was through this meeting that I found out just what my doctor had been saying behind my back to the pharmacist(s). That was straightened out in a hurry!
    I made sure that I stated to my pharmacist that I understand that he / pharmacists are between a rock and a hard place, with never ending changes in current guidelines, new guidelines, and of course, the various challenges at the counter. He did share with me his level of frustration at just what the government is attempting to do, without care for the legitimate pain patient. I am glad, despite the cause, that he and I had that time to talk and share. It makes for a better and more honest relationship.
    Between the government and the doctors, they are harming those of us who rely on our pain medications to live life. Even at that, I live half the life I used to live. Nor did I of my own free will create the damage that occurred to my body at the age of 10. It seems to be a game of blame. No one professional body will accept any accountability for their actions. I feel for those of us who suffer daily, who live in the US. It’s sheer bloody madness.
    Re the media … I was advised today of an Oprah special that is tonight I believe …. blaming opiate abuse for the rise in heroin use. I just wanted to scream when I saw the advertising for this program. Of all the pain patients that I know, and all that I join in various pain support groups …. we take our medications appropriately. We all have prescriptions. The one thing I would like to find out in this program, is just how many of those who abused opiates to the extent that they felt the need to go to heroin, were actually prescribed the medications. How many of them just wanted to get high, for the fun of it or to avoid personal emotional pain, and bought their drugs from the street.?
    It drives me mad when I hear of those who didn’t need the drugs for pain, gained the drugs through illegal means and now the taxpayer pays for their support through drug rehab programs, or jail. (I don’t personally feel jail is the place for such individuals).
    Interestingly enough, at my Pharmacy they always seem to have enough for my prescriptions and they are a small pharmacy. Yet if I have ever had to go to a WalMart, they have pulled the “oh we only have a week’s supply … can you come back” routine. I am uncertain as to Walmart’s protocols up here in Canada in house … if they share some of the more backhanded policies enforced in the US WalMarts.
    We just have to keep fighting for our health and our rights. Hopefully without more suffering, or god forbid .. deaths.

  11. Dennis Kinch at 7:53 pm

    Jacob! Tell it like it is! Is anyone listening? 10 years with same pharmacy and doctor. How legitimate does a patient have to be?

    Let me use this analogy again; “Imagine you’re on fire, and 5 people standing right next to you are holding water buckets, but they are fighting over who is at fault for not throwing their water.”

    How about everybody who claims to be in the Health CARE business start focusing their energies on the patient! Stories like Jacob’s are far too common.

    By the way, this survey is great and needs national media coverage. These numbers threaten to be the realest yet from a patient’s point of view. Get tough NPF!

  12. dave at 6:20 pm

    I agree with Dr. Shank regarding the need for fundamental regulatory change for it is clear whether it is the DEA, FDA, Big Pharma or medical organizations there is little concern for the rights of people in pain.
    The factionalism of pain care in America is all too obvious.It reminds me of “the embarrassment of riches” for the factions are rich with power and wealth at the expense of the needs of people in pain. Pain care in America has become theater of the absurd” Moreover it seems that the factions wish to increase their rights, profits, privilege and will continue to claim that what they want is equivalent to the public good.
    I guess as the saying goes life is a tragedy for those who feel and a comedy to those who think.

  13. Myron Shank, M.D., Ph.D. at 4:02 pm

    Until there is a fundamental change in the regulatory and law enforcement environment, the tragedy of medical and pharmaceutical personnel adding to the suffering of those with chronic pain will continue to worsen. Lecturing physicians and pharmacists about how badly they treat chronic pain patients is futile, because there are serious conflicts of interests between those who are in need and those who are able and ethically obligated to address those needs.

    While the DEA gets most of the publicity from the lay press, state medical and pharmacy boards bear the brunt of the blame for the rampant abuse of legitimate providers.

    “It’s not paranoia if they really are out to get you.”

  14. Jacob Hayden at 3:04 pm

    I think the whole situation is a bunch of BS the dea is trying to take away our American freedom and police everything do you know how crappy it is to have been going to the same dr. And Pharmacy for about 10years then last month I went to get my medicine filled for chronic pain due to a MVA head on collision I broke my neck in 3 spots well any way the Pharmacy told me there out and have no idea if or when they will have again because the dea and there new limits bullcrap so now basically the whole Pharmacy is shut down and will probably go out of business because thats how it maintains and makes the money to cover overhead to stay running because other medicines are purchased but not as much just selling antibiotics n stuff your couldn’t afford to stay afloat in today’s economy so now I have to run the streets searching Pharmacy after Pharmacy and that is so embarrassing and frustrating to have to do the dea and police need to stop terrorizing the citizens making it hard on us and do there job and go after real criminals and real drug traffickers that actually disrupt and hurt things