A patient whose pharmacist refused to fill his prescription for an opioid medication was ashamed after the pharmacist called him a “drug seeker.” He went home hoping to endure his pain. Three days later he tried to kill himself.
STAT, a pharmacy publication, reported that Dr. Barbara McAneny, the president of the American Medical Association, told this story at a recent AMA interim meeting.
I have been a practicing retail pharmacist for over 50 years and have always tried to fill the prescriptions for opioids as prescribed by the physicians and am very unhappy with a pharmacist who would say that to someone in pain. My colleagues and I were able to discern who was real and who wasn’t, which doctors were always prescribing CIIs, or heavy duty narcotics, with what appeared to be a free hand.
I was held up at gunpoint and with other assorted weapons nine times and fortunately not injured. Perhaps that pharmacist, and this is not an excuse for him, simply had similar experiences and just plain lost it. Most pharmacists try their best to fill the prescriptions as ordered by the physicians, but when they know something is amiss and they don’t want to fill it, they can find ways to avoid this situation.
I would frequently call a physician and ask for the ICD10 code for the medical condition the physician was treating. This is simply the code the doctor’s office uses to bill for the service without writing it out on the prescription. If the physician’s office would not cooperate with me and give me the information, I sometimes was not able to fill the prescription.
The Centers for Disease Control and Prevention published its guidelines for prescribing opioids for chronic pain in March 2016, which has caused pain patients to experience difficulty getting needed opioid medications due to denials by pharmacists and, in some cases, insurance providers.
The U.S.Centers for Disease Control and Prevention wants to make it clear: Its guidance on the use of opioids for the treatment of chronic pain is not intend to apply to pain related to cancer treatment, palliative care or end of life care.
Dr. Deborah Powell, CDC chief medical officer, issued a letter Feb. 28 restating the intentions around the prescribing guideline that recommends non-opioid approaches, including physical therapy, as a preferred first-line treatment for some, but not all, types of chronic pain. The government agency was restating its guidelines originally issued in 2016.
Stefan Kertesz and Kate Nichnolson, writing in April in the New England Journal of Medicine, said the guidelines have been useful for many clinicians, but they have been misapplied by individual prescribers, institutions and agencies, too often causing the kind of pain they were meant to address. The authors of the guidelines, Dr. Deborah Dowell and Tamara Haegerich from the CDC and Dr. Roger Chou from Oregon Health and Science University, noted that ranges given in the guidelines related to opioid dosages and the number of days for which an opioid should be prescribed were often translated to “inflexible limits that have been pushed, mandated, and incentivized by countless insurers, state agencies, and regulators in ways that exceed or even contravene the guidelines.”
Dowell, Haegerich and Chou have written of the “misapplication of a few select provisions in otherwise useful guidelines which wisely urge caution in starting and escalating opioids, has occurred at a breakneck pace since they were published, with real human consequences”
Patients in serious pain face delays and denials when they attempt to fill their prescriptions. Some doctors have felt compelled by the guidelines to put patients who have relied on opiods to safely and effectively manage pain, often for decades, on lower doses or take them off opiods altogether, even when they believe patients are benefitting from the medication because they fear oversight and liability.
According to the authors, the guidelines have also been incorrectly applied to people they were never meant to cover, such as those with pain associated with cancer, surgery, or acute sickle cell crises.
Strict limits on opioid prescribing risk the “inhumane treatment of pain patients.” Patients who are experiencing pain because of an accident at home that is causing much pain, but will be cured in a relatively short time with “Tincture of Time” are being given everything but an opioid for the first few days, including some anti-inflammatory drugs that take up to 10 days or more to kick in and provide relief, because of a fear of being too loose with the Oxycodone.
I am not advocating the free and easy use of CIIs. But understand, one or two days of such a drug could provide almost immediate relief. This could be then followed by other analgesics without the potential for addiction.
Bertram Drachtman
Great Neck
