March 26, 2013

FIRST! Do NO HARM...... RIGHT! Florida Dr,s should stand behind patients


Rx for Danger: Pain patients decry oxycodone shortage, but DEA says there isn't one

6:49 p.m. EST, September 29, 2012|
By Amy Pavuk, Orlando Sentinel
Throughout Florida, some chronic pain patients have complained that it is difficult — if not impossible — to get prescriptions for oxycodone filled at their local pharmacies.
Many of these patients are told the pharmacy is out of the painkiller. They think there is a massive oxycodone shortage, and the U.S. Drug Enforcement Administration is to blame.
And so when the DEA earlier this month banned a Walgreens distribution center from dispensing controlled substances to its pharmacies in Florida and on the East Coast, the measure no doubt caused more tension for some patients.
But DEA Special Agent Mia Ro said there is no oxycodone shortage in Florida.
What customers are experiencing is likely a combination of factors, industry experts say, including pharmacists simply being more cautious.
No one wants to be the next DEA target.
"What we're looking at here is a chilling effect," said Michael Jackson, chief executive officer of the Florida Pharmacy Association.
In an effort to curb Florida's prescription-drug epidemic, the DEA earlier this year blocked one wholesale-drug distributor from shipping controlled substances such as oxycodone and issued suspension orders against two CVS pharmacies in Sanford preventing them from selling controlled substances.
Many factors at play
Experts say other pharmacists and wholesale-drug suppliers who do not want to find themselves in the same position may be scaling back the oxycodone they are willing to dispense.
If a drug supplier notices a spike in orders of a particular drug from a pharmacy, the company could potentially restrict how much of that drug the pharmacy could buy or cut the store off altogether, Jackson said.
At the pharmacy counter, pharmacists can decline to fill prescriptions for a number of reasons left to the individual's judgment.
Sometimes, the store could truly be out of the drug. In some instances, experts say, the pharmacist may have caught customers lying about their medical history and other prescriptions or suspects the prescription is fraudulent or improper.
And some chains, such as CVS, have ordered their pharmacists not to fill prescriptions for certain drugswritten by doctors the companies have identified as "high-prescribing." At least 22 Central Florida physicians were notified late last year they were on the CVS list.
Compounding the problem is an influx of new pharmacy customers who used to get their painkillers directly from doctors, a practice largely banned by state law that went into effect in July 2011, Jackson said.
'Last line of defense'
So what do pharmacists do when they can't or are not comfortable filling a prescription?
They take the path of least resistance, explained Paul Doering, a professor at the University of Florida's College of Pharmacy.
"They will simply wash their hands of the situation by saying 'I'm sorry, we don't have this,' " Doering said. "Whether you do or don't have it, [the customer] will never know."
When asked whether CVS stores are experiencing an oxycodone shortage, company spokesman Mike DeAngelis said, "A pharmacy's in-stock position on medications may vary depending on the acute prescription needs of any one community. As such, it is not possible to comment broadly on the availability of a particular medication at every pharmacy."
Though they aren't trained law-enforcement investigators, pharmacists must attempt to identify fake prescriptions and customers who are doctor-shopping and abusing drugs.
It puts the professionals in difficult positions.
"We're trained to be health-care providers. Unfortunately we are the last line of defense in patients who may find themselves overdosing on prescription drugs," Jackson said.
Kevin Schweers, spokesman for the National Community Pharmacists Association, said some pharmacists may be limiting what they dispense out of an abundance of caution for liability purposes.
"In some cases, particularly Maine, we have heard that some pharmacies have voluntarily stopped carrying oxycodone and similar controlled substances due to the fear of crime or possibly for other reasons," Schweers said. "In other instances, we have heard that the actions of law enforcement have restricted the availability of these products from pharmaceutical wholesalers, tightening the supply."
DEA officials said they took action against Cardinal Health, one of the nation's largest wholesale-drug distributors, because the company did not have proper controls at its Lakeland facility. In May, the company agreed it would stop shipping controlled substances from its Lakeland center for two years.
The two CVS pharmacies in Sanford that can no longer dispense controlled substances included one that was Cardinal's top customer. CVS fought back. But earlier this month, CVS was notified the DEA had revoked its registrations for the two stores, preventing the pharmacies from selling controlled substances.

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