The U.S. Drug Addiction Problem is OUR Problem – My TEN Ideas

April 4, 2014 • News & Politics, Pharmacy Operations • Views: 4417

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.

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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.

©Jason Poquette and The Honest Apothecary.  Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Jason Poquette and The Honest Apothecary with appropriate and specific links to the original content.

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Author: Jason Poquette

8 Responses to The U.S. Drug Addiction Problem is OUR Problem – My TEN Ideas

  1. Steve Leuck says:

    Jason:

    You do describe straight forward attempt to limit narcotic abuse. I would add that item #3 and perhaps item #5 could be implemented today in any particular pharmacy with management approval. Any particular pharmacy/pharmacist can institute a contract with patients and their doctors and require certain parameters if they are to fill prescriptions. Also, re: item #5, a policy can be implemented today that we only fill 72 hours worth of any prescription from an emergency room. Let the patient and doctor know and then fill the Rx. If the patient doesn’t like it, they can take their Rx to the next store.

    I would also like to add the following two items.

    1. A required national pain treatment awareness campaign educating providers of all the non-narcotic pain treatment options, When patients are also titrated appropriately on some sort of nerve pain medication, possibly in conjunction with a NSAID and acetaminophen, in conjunction with heat, cold, physical therapy, medical acupuncture, massage therapy, topical pain meds and meditation (just to name a few), quite often their opiate medications can be decreased significantly; however, it takes motivation and education for the process to be effective.

    2. Take patient pain satisfaction scores out of the questions patients are asked when they are discharged from hospitals. Since the 70’s, opiate prescribing has increased, in part, because of poor patient pain satisfaction scores in hospitals, Hospital reimbursement from Medicare is correlated with patient satisfaction scores. Physicians with poor patient satisfaction either needed to step up an satisfy their patients, or move on. This trend needs to be changed.

    Thanks

    Steve

    • wellillbe says:

      My only concern with the idea of a pharmacist loosing their license for diversion would be that the DEA will not go after the docs who prescribe and yet if a pharmacist has a valid rx for a pain med, contacts the dr to ask if its a valid rx etc. and that pharmacy services pain patients they go after the pharmacist even when they are trying to do the right thing. I propose that if a Dr writes an Rx and a jury of other drs determines it wasn’t in good practice to prescribe based on available data the DR looses his license. Otherwise it puts the Rph in a position where they are damned if they do fill an rx (by the dea) and damned if they don’t fill the rx ( by lawyers saying patients were denied prescribed treatment….). Otherwise I like the rest of your proposals.

  2. jasonpoquette says:

    @steveleuck:disqus – Great thoughts! I’ve heard very little about the impact of those assessments on prescribing patterns, and what you say makes perfect sense. I would definitely add both your recommendations to the list!

    @wellillbe – I agree. When speaking of “diversion” above I was thinking about intentional diversion such as personal theft or generating bogus prescriptions or falsifying records, rather than an honest mistake made while trying to do the right thing. I wouldn’t want to see any physician or pharmacist lose their license while trying to sincerely help a patient, even if they are misled by that patient. Treatment contracts would help reduce this I think.

  3. Steve Leuck says:

    Jason: Here is an article I wrote on the subject; why opiates have increased in prescribing over the past 30 years and some suggestionis of what can be done.
    http://www.rxeconsult.com/healthcare-articles/Preventing-Opiate-Pain-Medication-Tolerance-444/
    Thanks
    Steve

  4. Pharmaciststeve says:

    The first thing that we are all missing.. is the ability to validate the driver’s license or social security of the person presenting the Rx. There are on-line databases of these things. If they are misrepresenting who they are.. what else are they misrepresenting. So you get someone to sign a contract.. who you don’t even really know who they are .. and you think that they are going to honor it ..
    If we can’t be assured that we have a valid ID.. why are we putting it into the state’s PMP? “garbage in garbage out”.. Did you ever wonder why the data going into a PMP is nearly transparent by the Rx dept.. but.. try to get a report back..is typically pretty time consuming. Why.. when the pt’s information is up on the screen we can’t hit a function key to request a PMP report ? The diverter is really our primary target.. They are the ones who are in business to get the drugs to the street.. those that abuse substances typically have some mental health issues.. monkeys on the back, demons in their head .. that they are self medicating. Our society would rather make criminals out of those with mental issues that goes down this path.
    IMO.. getting drugs to the street is job security for law enforcement/DEA.. their primary charge is not to prevent diversion but to arrest those that will divert.
    If you want to see what law enforcement is about in the war on drugs.. watch the 14 minute video on http://www.LEAP.CC.. explains a lot of the mindset.
    Really non-controlled meds for pain.. here is a recent article on the dangers of routine consumption of APAP
    http://www.realfarmacy.com/fda-finally-changes-recommended-dose-for-tylenol/#B368AZhLCvuER5lb.99
    http://www.realfarmacy.com/fda-finally-changes-recommended-dose-for-tylenol/
    Then you don’t want geriatrics to take NSAID.. because of intestinal bleed and possible cardio vascular issue.. heat and ice can only go so far.. and trying to keep a job and/or insurance not covering PT… puts this therapy out of reach for many.
    If you chart the per-cent of the population that has abused some substances since the Harrison Narcotic Act 1914.. it has never been less than 1% nor above 2%. It would appear to me that we have a larger population and more press releases from law enforcement and DEA. Everything else has remained the same for the last 100 yrs

  5. jasonpoquette says:

    Hey Steve! Always an honor to have you swing by. The ID issue is definitely a problem. You may be right about the % of the population abusing drugs. I think the deaths from OD have definitely gone up. But I advocate for the patient in REAL pain first. My sympathies for those who intentionally misuse the drugs is real…but second place to the dying cancer patient or other patient with chronic, painful conditions.

  6. Matthew Shapiro says:

    I like your suggestions, except for #3. T puts the pharmacist in the position of having the authority to decide whether the patient “needs” the medication — a determination best left to the medical doctor treating the patient. The duty of a good pharmacist is to ensure the patient receives the correct prescribed medication, in the correct quantity & dosage, and that they know how to take it properly. The pharmacist also serves as a safeguard against exploitation of soft-spots in the security, by watching for forged prescriptions and for doctor- and pharmacy-shopping.

    If pharmacists start second-guessing licensed medical doctors then you’ll be signing the death warrant for pharmacies — in the United States any M.D. can stock & distribute pharmaceuticals directly to their own patients; this is precisely where implementation of #3 will lead.

  7. jasonpoquette says:

    Hi Matthew,
    Thanks for your comments. Yeah, #3 is pretty radical. I guess I was mostly trying to think of ways to lock a patient on chronic or repeated narcotic therapy into a single source/supply chain. If you work near an hospital ER in a downtown city with poverty issues…you will see massive abuses of multiple doctors/pharmacies. The problem is that often they are small supplies (3-4 days) of narcotics. Patients go from ER to ER every few days. No overlap. Just very inappropriate patterns for supply. In this scenario even legitimate health care institutions (hospitals, doctors, pharmacies) are profiting from this abuse of the Medicaid system. No one is doing anything ‘illegal’ (except when/if the patient sells the drug they obtained) but it is fueling a huge social problem.

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