Pharmacy news, I have found, often reflects much more than scientific and medical innovations – it gives us a glimpse into what is going on in a culture in terms of their values, emotions, pains and problems. Right now all the pharma news and medical media are screaming one message very loudly: we’re confused and overwhelmed with the drug addiction and abuse epidemic in our nation.
We notice this in the nationwide debate about legalizing the use of marijuana for medical (and/or recreational) purposes. We sense our trouble in the rapidly approved new drug, Evzio, used by injection to immediately reverse the effects of heroin or narcotic overdose. Note, this drug is not primarily for emergency personnel…it is for patients and parents and people who want to be able to help save the life of someone who OD’s on drugs. Just this month Massachusetts made national news by instituting an emergency ban on the sale of recently approved prescription Zohydro ER, a long-acting narcotic for pain which some special interest groups claim is just too powerful to risk dispensing.
I could go on and mention Sudafed and methamphetamine and so on. The message is loud and clear.
And the message I hear is this: We have a drug problem, a BIG drug problem, and we don’t know how to stop it.
As a pharmacist I can’t ignore this issue. Every day I dispense and hand over to patients the VERY drugs that our nation is having a problem with. People are addicted to hydrocodone. I dispense hydrocodone. People are dying from oxycodone abuse. I dispense oxycodone. Acetaminophen toxicity is rampant, and it is a component of many analgesics we carry. The very pills that our CDC have indicated as connected with our “epidemic” of overdose deaths are passing through my hands into bottles which patients walk out the door with every day.
No pharmacist can say, in my opinion, “it’s not my problem.” It is your problem. And it’s my problem too.
But what is the answer?
That’s where it gets difficult.
Part of the difficulty, in my opinion, comes from the fact that we aren’t dealing with the issue honestly. I’ve written about that touchy topic elsewhere.
But right here, right now, I’m just asking about how we start to fix this. Imagine if in your state there were 1,000 deaths per year due to prescription drug overdoses. Imagine if your job, your ONLY job, was to cut that number in half. Furthermore, imagine that your paycheck decreased monthly until you hit that target – but when you DID reach the target, you got a bonus check for twice your annual salary.
What would you do?
Imagine. What if I had the power to actually make ANY changes to the law that I wanted.
Here is how I would fix the problem of prescription drug abuse:
1) Immediately offer a $500 cash reward to anyone who provides a tip leading to the arrest of an illegal drug dealer. We pay to buy back guns (which don’t kill anyone incidentally – people do!), why not pay for drug dealers who ARE killing hundreds and thousands per year.
2) Treat every convicted drug dealer as attempted murder. They are killing people. The numbers prove it. Stop being sissies about this. Make the punishment equal the crime. It’s murder. Worse than just killing someone in an unexpected rage. This is calculated, profitable murder.
3) Require EVERY prescription for a controlled substance to include a TREATMENT CONTRACT signed by the Physician, Patient AND PHARMACIST. Note: NOT the “Pharmacy.” I would require the contract to be signed by a PHARMACIST who works at least 40 hours per week. THAT pharmacist must approve every dispensing of a controlled substance for that patient. Period.
4) REQUIRE insurance companies to limit controlled substance prescribing to ONE pharmacy. Period. And NO mail order of controlled substances. Period. Single, 24 hour emergency overrides available.
5) Limit emergency department prescriptions for controlled substances to 72 hours of medicine. Period. Require the SAME contract to be signed (see #3 above). The SAME pharmacist must be used. One pharmacist per patient, no matter how many legitimate physicians they see. 24 hour emergency exception allowed.
6) Mandate that any insurance company MUST require a MINIMUM $10 copay on any schedule II, III or IV controlled substance INCLUDING Medicaid and Medicare Part D plans. This copay CANNOT be waived. Folks, we all know that the most effective way to move market preferences is by increasing the cost. Also, mandate that every health plan offer at least 3 NO COPAY non-controlled prescription analgesic options.
7) Require health plans to incentivize doctors to shift business toward non-controlled substance options for pain.
8) Require EVERY pharmacy to take back, for disposal purposes, ANY controlled substance returned by ANY patient. Period. We sell them. We should dispose of them.
9) Replace Police Chiefs and local Judges who fail to produce REAL results in decreased drug trafficking in their area. Sorry guys. I love my law enforcement friends. But welcome to the way the real world operates. Managers, leaders, CEO’s, professional sports coaches…you name it…they get paid for RESULTS.
10) Make the penalty for drug diversion by health care professionals simple: You lose your license for good. Period. Get used to this question: “Do you want fries with that?”
You may not agree with all of these 10 ideas. You may not agree with ANY of these 10 ideas. That’s okay. Feel free to list your ideas below. What our nation needs right now is not critics, but problem-solvers who know how to get things done. This problem is OUR problem. Let’s fix it.
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