Pharmacists across the country say “surprise disruptions” in the supply of opioid analgesics are forcing them to turn away legitimate patients with valid prescriptions for painkillers.
A survey of over 1,000 pharmacists conducted last month by the National Community Pharmacists Association (NCPA) found that most had experienced delays of at least one week in obtaining shipments of painkillers and other controlled substances.
“Vulnerable patients are increasingly and tragically becoming collateral damage in the country’s battle against the abuse of prescription drugs, particularly narcotic painkillers,” said B. Douglas Hoey, CEO of NCPA, which represents over 23,000 independent pharmacies across the United States.
“Community pharmacists repeatedly cited having their supplies or shipments of controlled substances abruptly shut off by their wholesalers, which may have done so due to perceived pressure, intimidation or a lack of clear guidance from law enforcement officials, such as the Drug Enforcement Administration (DEA).”
Wholesalers such as Cardinal Health are under pressure from the DEA to closely monitor their shipments of opioids and other controlled substances to prevent them from being abused or diverted. In 2012, Cardinal was fined $34 million after its distribution facility in Lakeland, Florida failed to notice suspicious orders of hydrocodone. Shipments of controlled substances from that facility were suspended for two years.
The unpredictable supply chain has led to rumors that opioids are being “rationed” in some parts of the country or that there is a quota system for each pharmacy that is determined by wholesalers or the DEA.
Cardinal Health declined to comment for this story, but a DEA spokesman strongly denied that the agency was trying to limit or ration access to narcotic painkillers.
“If a pharmacy chooses not to fill a prescription for someone, that’s their decision. It’s not the DEA’s decision,” Rusty Payne told National Pain Report.
Payne believes enforcement actions taken by the DEA against wholesalers and major pharmacies may have had a “chilling effect” on the companies.
“Typically we get blamed for a decision that the big wigs make at a pharmacy that’s run into trouble. They tell their folks don’t fill this, don’t fill that,” Payne said. “We don’t have the resources nor do we have the authority under the law to stand outside a doctor’s office and as you walk by say, ‘Let me see that prescription.’ It wouldn’t be a good use of our time nor would it be within the law for us to monitor what a doctor is doing on an everyday basis for a specific patient.”
In the NCPA survey, 75% of pharmacists experienced three or more delays in getting shipments of controlled substances in the past 18 months. On average, each delay or stopped shipment affected 55 patients-per-pharmacy.
Other key findings from the survey include:
- 89% of pharmacies received no advance warning of a delay in shipping controlled substances.
- 60% said the delays in receiving medications lasted one week or longer.
- 68% were unable to obtain controlled substances from an alternate source.
- Most reported having to turning away patients, including some cancer patients.
The survey included a comment section where pharmacists could share their observations about the impact delayed shipments had on their customers.
“We turn away patients on a daily basis that I am sure are legitimate patients with legitimate prescriptions with legitimate issues requiring pain management. I am one in a long line of pharmacies that turns these patients away because of the limits on what I can dispense monthly,” wrote one pharmacist.
“This situation has literally brought customers to tears in our store,” wrote another. “I fully understand the diversion and abuse of these powerful chemicals. I agree that something must be done, but to deny pain management to deserving individuals is inhumane at best. We have to find a way to curb the abuse and still provide relief from pain for those truly suffering.”
Another pharmacist wrote, “We try to scrutinize all controlled substance prescriptions, but are made to feel like criminals when trying to service our patients.”
“I’ve had firsthand experience with this,” says Steve Ariens, a retired Kentucky pharmacist who has had trouble filling prescriptions for his wife, who is a chronic pain patient.
“It really is pathetic,” says Ariens. “They’re picking on people who are physically, emotionally and financially drained.”
Ariens, who has a blog called Pharmacist Steve, believes drug store chains and wholesalers have overreacted to the DEA’s enforcement actions.
“They’re policing themselves with paranoia, in my opinion,” Ariens told National Pain Report. “I’ve tried to talk to attorneys about going after them, but when the DEA is involved they all throw up their hands and walk away.”