Five facets of the OxyContin dilemma
On February 22, 2010, around 8:30 p.m., Bradley Skinner walked up to the counseling window of a pharmacy in northeast Florida and caught the pharmacist’s eye. The pharmacist smiled and asked how he could help.
“I have a bomb, and I want all your OxyContin,” Skinner said.
The pharmacist half-turned toward the safe. Then he turned back.
“I’m sorry. What did you say?” the pharmacist asked, thinking he had misheard. Skinner repeated his previous comment.
“I have a bomb, and I want all your OxyContin.”
The pharmacist opened up the CII cabinet and handed Skinner five bottles of OxyContin. Skinner walked calmly out of the pharmacy to the car he had stolen. Street value of the drugs: approximately $7,000.
Three days later police were called to a hotel in the small town of Micanopy, Fla., where they found Skinner’s body. The toxicology report revealed that he had died from an overdose of OxyContin and other illicit drugs.
On March 15, less than three weeks after Skinner’s death, a white male wearing a dark jacket and baseball cap slid a note to the overnight pharmacist. The note stated he was going to “shoot the place up” if he wasn’t given what he wanted. He walked away with nearly 2,000 tablets of OxyContin.
April 8, 2011. Trevor LeFranc, sporting a baseball cap and dark sunglasses, approached a pharmacy technician. “Picking up or dropping off?” asked the technician.
“Dropping off,” he said, handing her a note that read: I want all your OxyContin and Percocet. He lifted his shirt to display the butt of a pistol in his jeans.
After robbing another pharmacy, LeFranc and two others were pursued by police. Following a high-speed chase reaching over 100 mph, their vehicle ran over police-deployed spike strips, struck a patrol car, and flipped over. The three individuals survived and were charged with robbery and grand theft.
Florida bill HB 7095 attempts to curtail the amount of pain medications being abused. The bill, which became effective July 1, 2011, targets so-called “pill mills.” The bill’s intent is to reduce the overprescribing of pain medications and deter physicians and pharmacies from facilitating the problem. Early indications suggest that the new regulations will decrease substance abuse.
One month after the bill went into effect, 33 people (including 13 physicians and one pharmacist) were arrested for prescribing/dispensing excessive amounts of opioids.
Where once pain patients could pick up prescriptions from most pharmacies with little difficulty, even across state lines, the practice has changed, due to escalating sales, robberies, and the DEA’s intensified focus on diversion.
In response, pharmacy measures to control abuse have steadily increased. Many pharmacies began by limiting pain prescriptions to a certain geographical radius or accepting prescriptions only from prescribers they were familiar with. Recently, pharmacies have further tightened control by instituting policies requiring pharmacists to contact prescribers on initial prescriptions for single-entity pain medications such as oxycodone and every 90 days for repeat patients.
Unfortunately, in several instances these policies have resulted in delays to patients waiting for prescriptions. Prescribers aren’t always available on weekends to confirm that yes, the prescription they wrote yesterday was in fact what they intended to write and yes, it was indeed written for the patient standing before you, who required it for the treatment of pain. Holidays? Vacations? Potential logistical nightmares for pain patients.
I don’t disagree with polices aimed at curtailing abuse. In fact, I embrace all effective measures to prevent abuse, having been on the receiving end of a death threat myself. The young man who demanded OxyContin and said he had a bomb was talking to me.
One of my professors, Paul Doering, once told our class that if you work retail pharmacy, it is very likely you will be robbed at least once in your lifetime.
He also taught us something else: that laws and regulations should not interfere with patient care. In preventing medication abuse, we have to be careful that we haven’t traded one tragedy, that of addicts dying from overdoses, for another - the tragedy of patients suffering needlessly.
Eric Egelundis a PhD candidate at the University of Florida. Contact him at firstname.lastname@example.org.