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DEA: Doctors and Pharmacies Responsible for Pain Med Denials

Posted on January 28, 2014 in Pain Medication

The U.S. Drug Enforcement Administration is not trying to limit or ration access to opioid painkillers, according to a DEA spokesman who says “nothing should stand in the way” of a patient getting a legitimate prescription for pain medication filled.

“We’re not doctors. We’re regulators and enforcers of the law. If something is prescribed for a legitimate medical purpose, we’re certainly not going to get in the way,” said DEA spokesman Rusty Payne.

For well over a year, many pain patients have told National Pain Report that their doctor refused to write any more prescriptions for opioids or that their pharmacy refused to fill them. In many cases, the doctors and pharmacists cited new rules or regulations and blamed the DEA.

“There have been no new regulations. There have been no rule changes. There have been no changes in the Controlled Substances Act,” said Payne.

“People will call us and they’ll say, ‘I can’t get my meds. And the pharmacy tells me that it’s your fault.’ It’s always popular to blame the government for something. We’ve been blamed in the past for having a chilling effect by a lot of people in the pain management community.”

That “chilling effect” stems from recent enforcement actions taken by the DEA against doctors, drug store chains and wholesale drug distributors.

Cardinal Health, one of the nation’s largest wholesalers, was fined $34 million in 2012 after it failed to report suspicious orders for hydrocodone at a distribution facility in Lakeland, Florida. Shipments of controlled substances from that facility were suspended for two years.

Walgreens and CVS Pharmacy have also been fined tens of millions of dollars by the DEA for violating rules and regulations for dispensing controlled substances.

Soon after the fines were levied, Walgreens developed a “secret checklist” to screen patients with narcotic prescriptions, and told its pharmacists not to fill them or to call the doctor if anything appeared suspicious.

“If a pharmacy chooses not to fill a prescription for someone, that’s their decision. It’s not the DEA’s decision,” says Payne.

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.

“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),” said B. Douglas Hoey, CEO of NCPA, which represents over 23,000 independent pharmacies across the United States.

Both the American Medical Association and the American Academy of Pain Management have been inundated with complaints from patients and doctors – not only about Walgreens – but about other pharmacies also making it harder for opioid prescriptions to be filled.

The Academy even created an online complaint form for doctors and patients who are having trouble getting prescriptions filled at Walgreens.

“Folks tend to overcorrect the other way to the point where it becomes a chilling effect and no one wants to do anything because they’re afraid we’ll be hiding out in the bushes,” said the DEA’s Payne.

Under the Controlled Substances Act, wholesalers are required to report to the DEA every quarter the amount of narcotics that they shipped or sold. That’s how suspicious activity is often detected.

“We do look at distributors and what they’re selling. And typically what we look for are patterns, like abrupt changes. So if we see that a distributor sells “X” amount that’s pretty steady and then all of sudden there’s a significant spike, we might want to ask questions why,” Payne told National Pain Report.

“We look for patterns. We take action on egregious violations. And CVS and Walgreens would be good examples of that,” said Payne, referring to the enforcement actions taken against the drug store chains.

And what about pain patients who get caught in the middle and can’t get their prescriptions filled?

“When it comes to opioid based painkillers, if a doctor prescribes you something like a Schedule III (drug) that is an opioid based narcotic, and it’s for a legitimate medical purpose, you shouldn’t have anything stand in your way,” said Payne.

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