January 22, 2014
Cancer Patients, Elderly Are Collateral Damage in Efforts to End Abuse of Narcotic Painkillers

Alexandria, VA—In a case of unintended consequences, patients who desperately need painkillers are having trouble getting them because of the continuing campaign to end narcotic abuse.

A survey conducted by the National Community Pharmacists Association (NCPA) asked more than 1,000 community pharmacists about the challenges in meeting the needs of patients requiring painkillers, such as the elderly and cancer patients. Among other issues, the respondents said the supply chain was unpredictable, making it impossible for pharmacists to guarantee that they would have medication each month for patients with prescriptions.

“Vulnerable patients are increasingly and tragically becoming collateral damage in the country’s battle against the abuse of prescription drugs, particularly narcotic painkillers,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “In the survey, 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).”

About three-quarters of the pharmacists who responded said that, over the past 18 months, they had experienced three or more delays or issues caused by stopped shipments with their controlled substance orders, estimating that an average 55 patients-per-pharmacy were affected by the supply chain disruptions. Of the pharmacies facing those problems, the vast majority, 89%, said they had received no prior warning, with 60% reporting that the delays in receiving the medication lasted at least a week.

With 67.9% saying that they were unable to procure controlled substances from an alternate source, such as a secondary wholesaler, most reported having to turn patients away and refer them to a local competitor.

In an open-ended section of the survey, community pharmacists had a number of strong comments, including:

• “It is a shame to watch an arthritic 85-year-old do without.”
• “This situation has literally brought customers to tears in our store. I fully understand the diversion and abuse of these powerful chemicals. I agree that something must be done, but to deny pain management to deserving individuals is inhumane at best. We have to find a way to curb the abuse and still provide relief from pain for those truly suffering.”
• “We turn away patients on a daily basis that I am sure are legitimate patients with legitimate prescriptions with legitimate issues requiring pain management. I am one in a long line of pharmacies that turns these patients away because of the limits on what I can dispense monthly.”
• “A few cancer and pain patients who really need their meds went without it for a few days. Has happened too many times.”
• “We try to scrutinize all controlled substance prescriptions, but are made to feel like criminals when trying to service our patients.”

The NCPA has urged Congress and the FDA to do more to protect patients while still combating prescription drug abuse. Those steps include measures such as electronic prescription drug monitoring programs and tracking systems, more effective education of prescribers, shutting down rogue pain clinics, offering more disposal options for excess medications, and more scrutiny of controlled substances delivered by mail order pharmacies.

Last month, the group took strong objection to an FDA recommendation to reclassify Vicodin and other hydrocodone-containing products from the Drug Enforcement Administration’s (DEA) Schedule III list of controlled substances to the more restrictive Schedule II list.

“Hydrocodone-containing products account for almost 3,000 different available combinations of strength, formulation and manufacturer. If these drugs are moved to Schedule II, patients suffering from legitimate, chronic pain will face new hurdles to obtaining relief,” Hoey told the FDA, pointing out that other effective ways exist to control abuse.

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