When government calls the shots: Pharmacists and pain management

February 10, 2014

An overly aggressive government is making a tough job tougher, but the pharmacist's first ethical concern must be for the patient.

Ken BakerPharmacist have a tough job, and over the last year it has gotten tougher. Caring pharmacists and suffering patients are feeling the effects. Pharmacists are being pressured into a “Do not fill” attitude toward often legitimate pain treatments.

Colleen Sullivan is a columnist. She is also a patient. Colleen suffers from muscular dystrophy, rheumatoid arthritis, scleroderma, mixed connective tissue disease, and other autoimmune-related disorders. She is constantly in pain.

In an article titled “My Story: Humiliated by a Pharmacist,” published in the National Pain Report, she relates a series of events that began with the refusal of her regular pharmacist to fill her oxycodone prescription because “it’s too soon.” This because the physician erred in writing "Take 1 q 4 h" instead of "Take 1 to 2 every 4 hours prn pain.") Then, giving Colleen what she described as a “You are a junkie” look, the pharmacist called other pharmacies in the area, after which they all refused to fill Colleen’s pain prescription. The story ends with Colleen in tears.

One customer, who asked not to be identified, told a reporter for WTHR television in Indianapolis that his prescription for pain medication, which usually had taken only a few minutes to fill, now, because of a new pharmacy policy, takes three and a half days. As a result, the customer, who “suffers from a debilitating combination of multiple sclerosis, fibromyalgia, and peripheral neuropathy,” ran out of his prescribed pain medication.

A mother who takes pain medications because of blood clots in her legs was turned away without her pain prescription by her local pharmacist, who gave no reason for the refusal.

The pharmacy police

Although not completely blameless, pharmacists have been forced into taking a policeman’s attitude by an overly aggressive federal government. The pharmacy industry has been intimidated into compliance.

While leaving doctors it suspects of operating “pill mills” with their medical licenses and DEA permits intact, the government pressures pharmacists to refuse to fill prescriptions written by those doctors.

With presumed good intentions of addressing a real problem of nonmedical use of prescription drugs, particularly opioids, the federal government has forced pharmacies into adopting policies that result in denial to patients of prescriptions written for legitimate medical purposes.

Dr. Deborah Peel, founder of the Patient Privacy Rights Foundation, has said, "Everyone - everyone - who has a pain prescription is being treated as a suspected criminal."

The AMA has also raised concerns about these new aggressive postures taken by the pharmacy industry.

First responsibility

Pharmacists have an ethical and legal obligation to protect prescription drugs from being diverted to nonmedical uses. But pharmacists are not policemen. Nor should they be made into agents of overly aggressive law-enforcement tactics.

Pharmacists owe a primary obligation to their patients. A pharmacist’s first ethical obligation is to “do no harm.” Patients in pain should not have to leave the pharmacy in tears with unfilled legal prescriptions in their hands written by licensed physicians, acting in the usual course of their professional practice, who are trying to treat the patients’ legitimate medical conditions.

The pharmacist has a tough job. The government should not make it unnecessarily tougher.

References

1. Sullivan C, My Story: Humiliated by a Pharmacist, National Pain Report, 8/5/2013, http://bit.ly/painstory, last accessed 1/7/2014.

2. Segal B, Walgreens’ 'secret checklist' reveals controversial new policy on pain pills, 9/18/2013, WTHR.com,  http://bit.ly/painlist, last accessed 1/7/2014.

3. Filosa G, Walgreens refuse Rx's from local docs, Doctor says pharmacists overstep authority by refusing patients' meds, 4/12/2013; Florida Keys Newshttp://keysnews.com/node/46864, last accessed 1/7/2014.

4. Foreman J, Backlash Against Walgreen’s New Painkiller Crackdown, 8/12/2013, WBUR Common Health (an NPR station),  http://bit.ly/wburpain, last accessed 1/7/2014.

These articles are not intended as legal advice and should not be used as such. When a legal question arises, the pharmacist should consult with an attorney familiar with pharmacy law in his or her state.

Ken Bakeris a pharmacist and an attorney. He teaches ethics at the Glendale, Arizona, campus of Midwestern University, and risk management for the University of Florida. He consults in the areas of pharmacy error reduction, communication, and risk management. Mr. Baker is an attorney of counsel with the Arizona law firm of Renaud Cook Drury Mesaros, PA. E-mail him atken@kenbakerconsulting.com.