Scrutiny Of Painkiller Distributors Harms Patients – Sally Satel, Contributor – Dec 2019
Anyone following the opioid problem knows about the delinquent practices of some drug distributors, the companies that deliver painkillers from manufacturers to pharmacies.
By transporting “suspicious orders” – regulatory code for unrealistically large shipments — to rogue pharmacies, they helped fuel the crisis of addiction and overdose.
This is like a history lesson from 10 years ago when this was happening. By now the overdoses are no longer from pills because they’re too difficult to get and too expensive. Instead, they use some powdered street drug (heroin, meth, cocaine) that’s been laced with undetermined quantities of fentanyl, frequently enough to kill them.
A crackdown was long overdue. But there’s an important untold story: distributors are now so spooked by class action lawsuits against them and the possibility of federal fines and even criminal action, that they are reducing the supply of pills available to patients in pain.
James DeMicco, pharmacist-in-charge at J and J State Street Pharmacy in Hackensack, New Jersey. On November 1, he learned that his distributor, AmerisourceBergen, would no longer supply his store with opioids.
DeMicco pored over thirty patient cases that the company had flagged as suspicious. Irregularities included his dispensing more than one controlled drug to a given patient and the numbers of out-of-state patients who patronized J and J, signals that perhaps the pharmacy was supplying pills to patients who were abusing them.
As DeMicco explained to the reviewer, many of his patients suffered “high impact pain syndromes” and required complex dosing regimens.
But these days, a doctor isn’t allowed to make decisions about a patient’s pain care because the government has already decided that we don’t need what our doctors want to prescribe.
Thus, some patients were prescribed two or more classes of controlled (addictive) substances, such as an opioid with a benzodiazepine (e.g. Valium) for muscle relaxation and/or a stimulant (e.g. Desoxyn) for chronic fatigue. And some of his patients traveled considerable distances to see the pain specialist in the adjoining office building – one of the increasingly few pain specialists who still prescribed opioids long term and in high doses for patients whose pain did not respond to other interventions.
the compliance officer at AmerisourceBergen, who had the final say in whether the company would remain DeMicco’s supplier, told him that shipments would stop.
The problem is widespread.
“Distributors are fearful of being held liable for patients becoming addicted or overdosing,” according to attorney Steven Cava, so they set limits on how much a pharmacy can order.
They are still going after pills, even though all the overdoses involve various combinations of other substances or other opioids.
It’s just easier to go after pills because they can be quantified, unlike the illegal drugs that are unmeasured and often deadly exactly for that reason.
The measured doses in opioid medications are NOT causing overdoses. It’s all about street drugs of unknown origin and unknown contents.
Oddly, those limits are confidential so pharmacies only discover they have breached them after the fact.
This bizarre type of “confidentiality” reeks of corruption and venality. There is no above-board reason to explain such secrecy – they are obviously hiding something.
a pharmacy in eastern North Carolina that recently began serving a facility caring for ailing elderly people. The added demand pushed the pharmacy’s orders over the undisclosed threshold so its distributor terminated the supply of morphine for the last twelve days of October.
Granted, distributor monitoring was egregiously lax in many cases between 2005 and 2016.
This is “closing the barn door after the horse is gone” because drug addiction and overdose have shifted away from pills to far cheaper street heroin/fentanyl.
distributors have admitted delivering huge quantities of opioids to pharmacies that colluded with shady physicians and that shipped directly to pill mills (bogus pain clinics prescribing opioids to virtually anyone who paid) and internet pharmacies.
In October, federal prosecutors initiated a criminal investigation into whether distributors and others allowed opioid painkillers to flood communities, potentially charging violation of he Controlled Substances Act, a laws normally used to go after drug traffickers, according to the Wall Street Journal.
And here again, we see how the drug-war has spread to the legitimate medical care of patients.
Walmart and Sam’s Clubs’ pharmacies, for example, have imposed daily limits per patient of 50 morphine milligram equivalents,
And if you’re a poor metabolizer of opioids, and need three or four times as much to get an effect… tough luck. They are treating numbers and statistics, not patients.
As for doctors, the story of their retreat from treating chronic pain patients has been well documented.
Physicians worry about losing their licenses lest they prescribe opioids and attract the attention of the DEA or their state medical boards.
Why can’t the under-treatment of pain “attract the attention” of state medical boards as well?
One patient called him in tears because five other pharmacies could not fill his prescription for buprenorphine, an anti-addiction medication that DeMicco would normay have in stock.
So it’s just as bad for people with addiction; they can’t get their medication either because it’s an opioid.
They need their medication just as badly as we pain patients need ours, to preserve some quality of life these days. Lack of medication can cause people to lose jobs, lose their homes, and end up on the street.
That’s the real drug crisis: people cannot get legal access to the opioid medication they need to treat an ongoing medical issue, whether pain or addiction.
All agree that judicious oversight and accountability are imperative.
“Judicious” is exactly what’s missing when blanket restrictions are placed on every patient, every doctor, every pharmacy, and every distributor.
But under intense scrutiny, distributors are practicing defensive medicine and unintended casualties –patents in pain — will surely mount.
I wonder how much worse this insanity will get before something changes. Perhaps more well-known people, those so often displayed in the media, need to suffer from a lack of pain treatment, someone like Oprah or famous musicians… who had to get theirs from the black market and were given unmeasured unofficial and poisonous doses of fentanyl they didn’t expect.