Once again, we welcome Dr. Dole’s expert opinion and insight, but this time on an important topic of pharmacy ethics. and Opioid Therapy.
Dr. Ernest Dole is Clinical Pharmacist at University of New Mexico Hospitals (UNMH), Department of Clinical Pharmacy/Pain Consultation and Treatment Center (PCTC); and Clinical Associate Professor at University of New Mexico Health Sciences College of Pharmacy. A comprehensive biosketh appears beneath blog post.
Dr. Dole writes…
Please take a few minutes and read this. It is much longer than the usual blogs posted here, but addresses an important issue to our profession.
Thank you.
Money doesn’t talk it swears
Bob Dylan; It’s Alright Ma, I’m Only Bleeding
Pharmacy has struggled with the nature of its duality; trying to balance the two agendas of being a patient care profession, or a profession driven by business interests. This duality is about to be exposed on a national stage with the business side of pharmacy being epitomized by Walgreens Pharmacy’s newly implemented, “Good Faith Dispensing” (GFD) policy.
Appearing as a result of Walgreens selling BILLIONS of doses of opiates in Florida, Walgreens and the Drug Enforcement Agency (DEA) entered into a Memorandum of Agreement (MOA) in 2011. Additionally, on fall 2012, the DEA issued an Immediate Stop Order (ISO) at Walgreens Distribution Center Jupiter, Florida because their business constituted an imminent danger to the public safety (1). In response, Walgreens has resurrected a policy that they allege has always been on their books, their GFD policy. Their current enforcement of the GFD policy is an attempt to shift the payment of their sins to the DEA, over to the patient and provider, and to insulate Walgreens by employing the verbiage of patient care. Walgreens maintains that it is a business with patient safety as their main concern. The closest that Walgreens’ GFD policy comes to patient safety and patient care is that these words are used in a maneuver to provide the needed window dressing so that their GFD policy appears as if patient safety is the organzations primary goal.
The heart of this policy is Title 21 of the Code of Federal Regulations, Section 1306.4 (2) which explains that a pharmacist has a corresponding responsibility to ensure that any prescription for a controlled substance that is dispensed is done so for a legitimate medical purpose (3). This is totally appropriate, valid and justified. This is part of a pharmacist’s role. However, Walgreens has warped this concept into a clever marketing action designed to give the illusion of this company’s commitment to patient care. Ironically, this policy places patient safety at risk by obstructing the delivery of patients’ medication as it requires the gathering of information above and beyond requirements set forth by state and federal regulations before an opiate prescription for chronic non cancer pain (CNCP) may be dispensed to the patient.
It is standard practice for a business to educate its employees on new initiatives prior to implementation of that initiative in order to optimize successful execution of the agenda. Walgreens has, at best, performed sub-optimally in educating their pharmacists as to the goals and objectives of the GFD policy. At worst, their efforts could be construed as a deliberate attempt at mis-information. Walgreens is apparently misinforming patients and providers for the reasons this additional information needs to be collected by telling them any combination of the following: that the DEA has issued new guidelines; that and/or the Board of Pharmacy has enacted new regulations; that the patient’s insurance company is requiring this.
Further confusion exists as to the “guidelines given by the DEA” to limit quantities of certain opiates to #120 doses. Per the Deputy Assistant Administrator, Office of Diversion Control, DEA, (in a personal discussion) the DEA does not issue therapy “guidelines”. Additionally, there are reports that Walgreen pharmacies are not only limiting the quantity of an opioid prescription to 120 doses, but then requesting from the provider a second prescription for the remaining balance of the first prescription. It is unclear how this protects the patient, however it does allow the Walgreens pharmacy to collect copay for the first prescription and then requires the patient to pay cash for the second prescription. By implementing such a policy, Walgreens is giving the appearance of protecting the public and fulfilling its obligations to the DEA, and at the same time profiteering in their implementation of a policy that obstructs the delivery of prescribed medication to the public. As a business, Walgreens wins on all accounts. As a company that states patient care is its primary goal, there is a level of hypocrisy.
The most disturbing element of Walgreen’s GFD policy is that while promoting the concept of “corresponding responsibility”, there is no advocacy for “corresponding accountability” of the Walgreens pharmacists. There can be no responsibility without accountability. The question exists as to how a Walgreens pharmacist is to be held accountable for “prescribing by omission” if there were an adverse event that occurred because a patient’s opiate prescription being dispensed was delayed due to their GFD policy.
You’ve left it for somebody other than you to be the one to care
Jackson Browne; Rock Me on the Water
Walgreens’ implementation of its GFD policy and the subsequent risks to the public is a pharmacy profession issue. It is deeply concerning that no State Board of Pharmacy, or pharmacy professional organization has deemed that Walgreens is participating in unprofessional conduct. The ethics of this speaks to the Oath of the Pharmacist that states, “A pharmacist acts with honesty and integrity in professional relationships “ and “A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner”(4). In Virginia, the State Board of Pharmacy ruled that Walgreens’ actions appeard to violate no rules or regulations of that state. In New Mexico, the State Board of Pharmacy (NMBOP) defines unprofessional conduct as, “Participation in a plan or agreement which compromises the quality or extent of professional services, or facilities at the expense of public health or welfare”(5). By this very definition it seems clear that Walgreens is engaging in unprofessional activity in New Mexico; just by reading this regulation, the issue seems cut and dry. In an effort to have the GFD policy investigated as engaging in unprofessonal conduct, New Mexico Congress-woman, Michelle Lujan Grisham has sent a letter to the NMBOP outlining her concerns and requesting that the GFD policy be put on hold until these concerns can be addressed. (6).
As the Walgreens GFD policy is a pharmacy issue, it is further distressing that state and local medical groups have moved forward to take action against Walgreens. The California Medical Association, in cooperation with the American Medical Association (AMA), has expressed outrage regarding the GFD policy, yet no action has been taken to date by any California pharmacy organizations (7). Further, the New Mexico Medical Society (NMMS), in cooperation with the AMA, has placed on their website a form for reporting problems with Walgreens handling of patients’ opiate prescriptions and a letter to providers outlining the efforts that NMMS has performed to address this issue. (8).
Which side are you on
Florence Reese, Which Side Are You On
There are obviously multiple layers to this issue. There is the fact that there is an epidemic of abuse of prescription opioids; one that is hitting our teenage population especially hard. There is the fact that Walgreens is in a tough position by needing to fulfill the terms of an MOA they made with the DEA. There is the issue of a retail pharmacists having corresponding responsibility with no corresponding authority. But in the end, as a definition of unprofessional conduct, as defined by the NM BOP is,” Participation in a plan or agreement which compromises the quality or extent of professional services, or facilities at the expense of public health or welfare”, then Walgreens is engaged in unethical practice as evidenced by:
- The delay in dispensing opiate medication to a patient in order to gather data per their internal GFD policy that is above and beyond any state or federal requirements, which exposes patient’s to safety risk and compromises the quality of professional services.
- The fact that patients, against their preference, had to change pharmacies in order to get the prescribed amount of opiate medication dispensed to them has compromised the quality of care that Walgreens pharmacies are able to deliver.
- The fact that Walgreens has done at best a sub optimal performance in educating their pharmacists’ as to the goals and objectives of the GFD policy, and at worst a deliberate attempt at mis-information as evidenced by the fact that Walgreen’s personnel are apparently misinforming patients and providers for the reasons this additional information needs to be collected. This compromises Walgreens’ integrity and credibility which compromises the quality of professional services.
- The fact that Walgreens may be profiteering from implementation of their internal GFD policy by asking providers for a second opiate prescription to make up the balance of the original prescription that is greater than #120 doses requiring the patient to pay cash for the second prescription has negatively impacted on Walgreen integrity and credibility and decreased the quality of professional services.
- The fact that there is no “corresponding accountability” for a Walgreens’ pharmacist for “prescribing by omission” if there was an adverse event that occurred because a patient’s opiate prescription being dispensed was delayed due to their GFD policy has compromised the quality of care.
There is no other health care profession that would allow this. If pharmacy wishes to maintain its integrity both within and outside the profession, it cannot mutually support the position that pharmacists should be federally recognized providers and support the GFD policy Walgreens Corporation is implementing. If the profession of pharmacy wishes to continue its covenant with society, it cannot both support provider status for pharmacists and have pharmacists “prescribing by omission” as Walgreen pharmacists are doing. We are either who we say were are, or we’re not. Our words and policies mean something or they don’t. Please take some time and act to stop Walgreens Corporation from defining what pharmacy professionalism is! If this is happening in your area, please feel free to copy and utilize Congress-woman Lujan-Grisham’s letter to the New Mexico Board of Pharmacy and the New Mexico Medical Society Reporting Forms.
I know that this is a long blog post, but I sincerely thank you for taking the time to read this.
References
- 1. DEA Serves a Suspension Order on Walgreens Distribution Center in Jupiter, Florida. http://www.justice.gov/dea/divisions/mia/2012/mia091412.shtml. Accessed 4.26.13
- Title 21, Code of Federal regulations, section 1306.4.http://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_04.htm. Accessed 4.26.13
- Good Faith Dispensing provider letter. Walgreens Company. Received 4.27.13
- Oath of a Pharmacist.www.pharmacist.com. Accessed 4.24.13
- New Mexico Code of Regulations. 16.19.4.7
- http://lujangrisham.house.gov/media-center/in-the-news/rep-lujan-grisham-sends-letter-to-nm-board-of-pharmacy
- http://www.cmanet.org/news/detail/?article=walgreens-refuses-to-fill-some-controlled
- www.nmms.org/news/2013/
Ernest Dole, PharmD, PhC, FASHP, BCPS
Dr. Dole is Clinical Pharmacist at University of New Mexico Hospitals (UNMH), Department of Clinical Pharmacy/Pain Consultation and Treatment Center (PCTC); and Clinical Associate Professor at University of New Mexico Health Sciences College of Pharmacy. At UNMH PCTC, Dr. Dole manages ambulatory care patients with chronic pain, as well as participating on an inpatient Pain Service. He received his B.S. in Pharmacy from Colorado, with honors, and his Doctor of Pharmacy degree from Tennessee. He completed an ASHP accredited Clinical Pharmacy Practice residency at Memphis VAMC, 1988. Dr. Dole was the ninth Pharmacist Clinician in New Mexico in 1996, was recognized as an ASHP fellow in 1997, passed the Board of Pharmaceutical Specialties Pharmacotherapy exam in 1997, and Certified Diabetes Educator exam in 2000. Dr. Dole has twice been nominated for the NMSHP Pharmacist of the Year. He has been the Chair of American Society of Health-System Pharmacists Section of Home, Ambulatory and Chronic Care Practitioners and has served as a member on ASHP Councils and Task Forces. He has been president of the New Mexico Society of Health-System Pharmacists in 2008-2009. Dr. Dole received the Volunteer Faculty of the Year Award and Preceptor of the Year Award from University of New Mexico Health Sciences College of Pharmacy in 2009. In 2012, Dr. Dole received the Dorothy Dillon Memorial Lecture Award from the New Mexico Society of Health System Pharmacists. This is the organization’s highest honor. His research interests include the impact of culture on pharmaceutical care, substance abuse in the elderly, and obtaining federal recognition of pharmacists as healthcare providers. His research interests with respect to chronic pain control include the effect of high opiate doses on testosterone levels, the effect of opiates on sleep apnea, and the use of non-opiate medications in the therapy of chronic non-cancer pain.
I have worked in the Health care field for most of my adult career. I DO NOT use Walgreen’s due to one experience when attempting to fill pain medication from a highly respected M.D. from the moderately sized city in which live. My medical HX is a long series of misdiagnosis, failure to treat, and other non-professional actions/dis-actions, that caused me to be taken out of work by a team of medical professionals. I tested + for Lyme dx, co-infections, rocky spotted mountain fever, septicemia, severe uveitis/Iritis (2 yr acute with zero response using methotrexate and pounding with steroids from every source, pnemoccocal pneumonia, and shortly after arriving by ambulance when into hypoxic respiratory arrest. I spent 1 month in ICU,my prognosis was ‘Guarded”. I am 52 yrs old. Live alone with young grown kids all out on their own earning their own living and succeeding. I was in a VERY abusive situation, while I was sick,recovering and in Hosp. he cleaned me out. Drained every penny I Had saved when I was working my last job as a Home Health & Hospice Nurse; he took ,$9858.00. The Bank(BOA) said they could do ‘nothing’ because he has found my pin. I realize this has little 2 do with the subject matter at hand. But I just wanted top[int out that MANY of not MOST of us dealing with ongoing Chronic pain conditions are often in situations that are “FAR, FAR ‘from easy. The LAST thing we need is going to get a medication that a Medical Dr. has ordered for a reason.I DO NOT agree the pharmacist should have ANY, NONE, NO BUSINESS making judgement calls what-so-ever. At least not in my case. And in many more i am sure. We are not choosing to have medical illnesses that leave many of us baffled, weak, disoriented,scared. and often alone.I wish All my fellow patients the best of Luck, hope you don’t get Harassed, and are treated with dignity and respect that you deserve!! Thank you. I have a GOFUNDME acct. which I had too set up to help me get heat, transportation,and so i can keep my Mobile Home as I really have no help and Its hard to get any supports no matter how bad your situation is. Its Oct. 10th and i still have no heat as of yet in my M.H. I have an appt. for fuel asst. in Dec.. Good Luck all and God will help you, keep your FAITH. It did help me a lot! Janice Brady
I can’t agree more. I’ve been seeing my primary care doctor for over 15 years. Like my sister who is an MD, she had 16 years of training. and more than 20 years experience, dealing with real patients. What do pharmacists know? They get a master degree to qualify for their jobs. They do not deal with patients.
I recently had a devastingly painful, bone sawing horrific surgery. My surgeon is a leading expert in this. I got so much grief, even the day I was discharged from the hospital filing the pain med prescription. The only reason I was able to get through it is because I have seldom finished a narcotic prescription, and I happened to have a lot of left overs collected over several years. I guess i should turn myself in.
Severe pain is a horrible disease. A study, conducted over decades of more than 20,000 battle field injuries showed an incredible result: Soldiers who were given morphine, on the battle field had 75% less cases of PTSD. But let’s not risk them becoming another opioid casulity.
To me, it is absurd, and ridiculous to ascribe the problems with abuse to doctors’ prescriptions. It is the Mexican drug cartels, and the illegal Chinese chemists creating defective cheap fentanyl that is causing deaths. Why doesn’t Jeff Sessions go after them.
Enough! Let doctors be the ones to determine if someone has an abuse problem.
When will this idiocy stop, and sense and reason again become a mainstay of the American way.
After reading so many of yalls comments and especially the blog, I feel I have found fellow chronic pain sufferers that will understand me and my constant battle with doctors and pharmacy. I have been a chronic pain sufferer for over 20 years. I have spent that length of time trying to prove myself to be in pain. There is so much politics in being a pain patient. I suffered with headaches and migraines. After many attempts and Dr appt trying to find a Dr that was interested enough to find out why, instead of just putting a band aide over it, I found one that was affiliated with one local hospital, he referred me to a neurologist, my insurance would only cover certain ones that happened to be affiliated with another hospital. No problem until I had an emergency and had to go to the ER. The ER Dr verbally attacked me, accused me of Dr hopping, and hospital hopping. He said I was the reason Drs fired patients. I was supposed to stay within one clinic, one hospital. Never gave me a chance. Never examined me, discharged me. The rules seem to be one Dr, one clinic, one hospital. For 5 years I was treated like a lying manipulative drug seeker, Dr hopper, hospital hopper. I was referred to a pain management center. After several unsuccessful epidural, I spoke to the Dr about still suffering daily. He said that I was sent there for injections not pain management. I was finally blessed with information about an anesthesiologist who specialized in pain management in another state. After evaluating me and actually studing my , I was diagnosed with 2 herniated discs and degenerative disc disease in my neck. heMRI began treating me with a pain medicine treatment, and a series of injections, within 4 months I was headache and migraine free. I’ve always heard from ers and nurses to use just one pharmacy. Otherwise they believe you are up to know good. Sometimes you have to use different pharmacy. I’ve been accused of that also. But like Walgreens, they filled all my meds for over a year, 2 months ago the pharmacist told me that I didn’t not meet the companies criteria to fill my Narco, they didn’t have a problem for a year prior. But all of a sudden I don’t meet their criteria. I was welcome to take it anywhere but Walgreens. So now I’m using 2 different ones. I asked what exactly was the criteria, she said they had guidelines to follow, and I dint meet them But I met them last month and eleven months before. Now it’s ok to us a couple of different pharmacy. Make up my mind!!! One clinic, one Dr one hospital, one pharmacy, but they can send us anywhere they want but the patient gets treated like a drug offender because of it. So many rules, for the chronic pain patient to still suffer. Sorry to ramble, it just sets me off, to make your patient suffer even more,
I AM A RETIRED ( DISABLED) CA. FIREMAN. MY WORKERS COMP PROVIDER HAS BEEN FANTASTIC. MY DR. IS SUPERB. WALGREENS PHARMACY (MAIL ORDER) HAS BEEN WONDERFUL! I
I SUFFER FROM SPINAL INJURIES AND INTRACTABLE PAIN. MY BROTHER DIED OF CANCER AND NEVER TOOK OPIOIDS! HE SMOKED MARIJUANA FOR GLIOBLASTOMA MULTIFORMA STAGE FOUR.
MY PAIN IS NEUROPATHIC AND ORTHOPEDIC. OPIOIDS WORK VERY WELL FOR MY CNMP.
MY DR. WRITES FOR 3 MONTH SUPPLIES OF METHADONE 60-80 MG/DAY, OXYCODONE IR 40 MG FOR BREAKTHROUGH PAIN AND CLONAZAPAM 1MG/DAY FOR MUSCLE SPASM AND SEISURE CONTROL. I HAVE BEEN ON THIS REGIMINE FOR 12 YEARS!
EXPRESS SCRIPTS GAVE ME LOTS OF PROBLEMS! WALGREEN MAIL ORDER HAS BEEN VERY GOOD. SHORTER SHIPPING TIMES, SUPERIOR MEDICATION BRANDS AND EXCELLENT CUSTOMER SERVICE.
THE DEA UNDER OBAMA IS OUT OF CONTROL! EVERY RX. MUST BE SCRUTINIZED BEFORE LEAVING THE DR.
DEA# SPECIFIC INSTRUCTIONS (FOR EXAMPLE: METHADONE FOR PAIN! NOT ADDICTION!) AMOUNTS DIRECTIONS ETC…MUST BE SPECIFIC. INSURANCE INFO. AND ALWAYS INCLUDE A VALID DL. OR PASSPORT COPY WITH RX REQUEST.
INCLUDE YOUR PH. # & ADDRESS AND DR. S INFO. MORE INFO IS BETTER. ONCE AGAIN. DEA # MD’s SIGNATURE & PH. #.
BE THOROUGH! IF YOU COMPLY WITH THE PHARMACY’s NEEDS THEY WILL BE GLAD TO HELP YOU. I GET 90 DAY SUPPLIES VIA MAIL ORDER. WALGREENS HAS BEEN VERY HELPFUL SO I THINK THE PROBLEM AS USUAL US WITH THE DEA THREATENING MD’s AND PHARM. D’s!!!!!!!!
IT’S EVEN WORSE UNDER TRUMP. WE HAVE AN OPIOD CRISIS, BUT IT’S NOT FROM PATIENTS IN PAIN. THE ONLY THING THE DEA HAS DONE IS TO PUNISH PEOPLE WHO ARE IN PHYSICAL PAIN. THOSE SEEKING TO GET HIGH ARE STILL GETIING HIGH AND WILL CONTINIE TO DO SO, OPIODS OR NOT. THEY’LL JUST GO BACK TO METH OR SOME OTHER DRUG. THE PROBLEM IS NOT PRESCRIPTION PAIN MEDICATION. THE SOLUTION IS NOT TO CUT OFF ACCESS TO PAIN RELIEF FOR PATIENTS IN PAIN. THEY NEED TO ADDRESS THE ISSUES WITHIN OUR SOCIETY THAT LEAD PEOPLE TO SELF-MEDICATE FROM THEIR PROBLEMS AND EMOTIONAL PAIN, AND OFFER HELP FOR THOSE WHO ARE ABUSING DRUGS AND ARE ADDICTED. WHAT THE DEA HAS DONE IS SUCCEED IN PUNISHING PEOPLE IN PHYSICAL PAIN BECAUSE OF THE HABITS OF PEOPLE SEEKING TO GET HIGH. CONGRATUALTIONS DEA, HERE’S YOUR SIGN.
For the las 2 months I have been told by Walgreens Pharmacy they did not receive my pain medication script from doctor I have had to go back to his office have him verify he sent they still deny so he has to send again it takes all day to get straightened out . They advertise 24 hr service but I’m told I cannot pick up any controlled meds including adderall until after 8am so between 12am until 8am in morning I’m not allowed to pick up meds from 24hr service pharmacy . They tell me it’s the law . I’m ready to change pharmacy again befor it was cvs harassing me over my prescriptions I’m 64 years old on minimum amounts reduced by Drs. Whom also will not adjust amounts effectively and now the pharmacists are telling me they are just concerned and have to check on my health issues I pay for private insurance and I feel harassed violated and tired of being treated like some misinformed drug-seeking imbecile when did pharmacy’s hire pharmacists to police my private medical care and intake of Dr. prescribed meds . This is out-of-control. Just venting a little I’m tired of the disrespect and outright lies for explanations of personal rudeness and absolute unnecessary control over my life my pain . There is no customer service just customer policing!
People buying Heroin, and Fentanyl. on the streets is the ‘ opioid crisis” I know NUMEROUS people in N.Y that O.D.d and DIED from opioids. Not one died from pharmaceuticals. They died from HEROIN/ FeNTanyl. Yet, I’ve been on my pain meds for 30 years so I can work and have a quality of life, as I take my meds as prescribed. Just last month Walgreens refused my prescription after 30 years, because the pharmacist thinks I’m taking 5mgs too much…Luckily I went to another pharmacy and got my prescription filled. For how long? I don’t know. As Everyone is targeting ligit Drs. And patients. Get the heroin and fent and meth off the streets and let the Doctors do their jobs helping people in chronic pain to a better quality of life.
I fully agree with your post! I was on a high dose of Fentanyl for many years. It made me feel like I could conquer the world and helped me through the deaths of my husband, son and mother within a three year period. I weaned myself off of it with the guidance of my two other children. It was time to face reality!!! Anyway, Walgreens has made me wait an extra day for my prescription meds the last few months, even though my physician and insurance say it’s okay to fill. I have been on this pain medication for many years and would not be a be to hold a job without them. My work hours vary and the local Walgreens pharmacy is not a 24 hour one. It is very frustrating! Do they have the legal authority to do this?
I totally agree with you!!! I was on a very high dose of Fentanyl patches for a few years. They made me feel like I could conquer the world. They also helped me through the deaths of my husband, son and mother within a three year period of time. I realized how dangerous the patches were and did not want my other two children to find me dead one day of an o.d., after everything they’d been through already. It was time to face reality!!! So I weaned myself off of them. Currently I take prescription opiates and have for many years. (Before, during and after being on Fentanyl.) Anyway, Walgreens has been making me wait an extra day or two to fill my meds, when it has already been okayed by my physician and insurance company. I would not be able to work without them. My work hours vary and the local Walgreens is not open 24 hrs. a day. It makes it very difficult and frustrating! Does Walgreens have the legal right to do this? Any helpful reply would be appreciated.
my sister in law suffers from a rare lung disease and was gave a script for oxycodone went to walgreens to fill it and they told her they couldnt fill it because of the GFD list then they give the script back to her and tell her that she can fill it at some other pharmacy well walgreens has wrote on the script so no other pharmacy will take the script. we live 60 miles from town and it makes it real hard to get her pain meds. makes me feel that walgreens does not care about their pharmacy patients at all
Melissa,
What state are you in?
I have waited more than 2 weeks to get my scrip filled. I have heard them all from the DEA is cut us back , they are not sending what was have order to your are to early from my last refill which was two weeks late. I have all the problem from a botched operation on my back to bone degeneration. What is a man to do, write my congressman “right” . Did that and nothing. Just about to the end of my wits.
“If Walgreens is truly a “patient safety first” organization, than this policy would have been put in place before BILLIONS of doses of oxycodone were sold in Florida causing patient harm.” — Does this mean you agree with the policy but you don’t like the timing? You would’ve been okay with it if this was done before DEA started investigating Walgreens? Many of us would be much happier if pharmacists could come up with GFD even before we had this opioid overdose on our hands.
“Walgreens GFD policy has components of state and federal regulations that guide the dispensing of controlled medication, however stating that it is “trail-blazing” and implemented for patient care, is the height of hypocrisy and corporate spin. The rigid enforcement of the GFD by Walgreens is because the corporation is much more worried about fulfilling requirements promised to the DEA, than patient safety.” — Perhaps the true motive of the policy was satisfying DEA. But that doesn’t make the policy itself evil; opoid overdose is a public health issue and someone has to do something. Why don’t you blame the DEA/state/federal regulations for this?
“Prescribing by omission”— What about a pharmacist delaying to fill prescription for a potential drug-allergy or life-threatening drug-drug interaction and trying to contact prescriber(s) for more information? Is that an omission too? Drug overdose was the leading cause of injury death in 2012. Of the 41,502 drug overdose deaths in the United States, 22,114 (53%) were related to pharmaceuticals. Of the 22,114 deaths relating to pharmaceutical overdose, 16,007 (72%) involved opioid analgesics, and 6,524 (30%) involved benzodiazepines. Let’s not pretend this is not an issue. And let’s be upfront in dealing with it, instead of encouraging pharmacists to have to lie that they don’t have it in stock or act like pill-vending machines. It’s a shame that some of the more educated of pharmacists want to turn their fellow pharmacists into pill-vending machines.
Walgreens does not require opioids to be filled with 100% utilization of last fill. Most pharmacists will dispense Rx 2/3 days sooner. Most pharmacists will contact prescriber for more information same day Rx is dropped-off if not in same hour. It’s a shame that prescribers are unable to respond within 48 hours to some very specific questions about a patient’s care which leads to delay in a patient receiving the medication. Sure some pharmacists incorrectly quote DEA/federal regulation for needing the information and Dr. Dole wants to blame all pharmacists working at Walgreens for doing the same. What about MD’s who quote HIPAA as a reason for them being unable to respond; how about Dr. Dole blame the WHOLE medical profession for being too arrogant to share patient care duties with other professionals (including the ones that are not their pets).
No quantity limitation was set in the GFD. So please correct your statements regarding 120 doses. Moreover, the pharmacist who lies about not having a certain opioid in stock for what he/she thinks is a questionable Rx is doing more disservice than the one who is giving 120 doses. Quantity limitation mostly comes from insurance plan limits. News flash: most medicare part D plans now require RPh to put in override code for certain opioid Rx’s stating prescriber DEA was validated and/or prescriber consulted regarding High-dose or apparent drug misuse. Let’s not just blame one pharmacy chain for creating this mess.
You are not even considering the amount of fraudulent prescriptions that this policy can prevent from being dispensed. It already has. Surely some of the prescribers’ whose name was fraudulently used will appreciate this.
We all feel bad for every legitimate pain patient suffering because of this and we realize we don’t have a perfect system yet. Sometimes we all pay a price for a few bad guys in our society. When I have to go through a long traffic for a random DUI checkpoint on my way home after a long day at work and have to answer an officer whether I had anything to drink when I clearly haven’t tasted a drop of alcohol in my life, I don’t throw a fit on my blog.
You have to agree something had to be done. One pharmacy chain was the first to do something (perhaps because DEA went after them but whatever the motive) and confronted it upright. Others are doing it too now internally. To be realistic, you cant expect every single pharmacist to get things right and demonstrate the utmost display of professional behavior when handling such delicate situation and not being able to lie about not having it in stock. Some bad apples will even refuse without even making an effort to review PMP or contacting prescriber. But please don’t blame the policy because of that.
But beyond anything else let’s get to the root of this problem. Let’s talk about where did this problem originate from. In May 2007 the Purdue Pharmaceuticals pleaded guilty to misleading the public about Oxycontin’s risk of addiction, and agreed to pay $600 million in one of the largest pharmaceutical settlements in U.S. history. Its president, top lawyer, and former chief medical officer pleaded guilty as individuals to misbranding charges, a criminal violation, and agreed to pay a total of $34.5 million in fines. Any comments on that Dr Fudin? Please tell us if you’re associated with Purdue in any way.
What about the doctors who are running pill mills? Accepting cash payments from medicaid and medicare patients in return for opioid prescriptions. And it’s all our tax dollars that pays for that prescription at the pharmacy and feeds the addiction. Your ideal pill-vending pharmacist would not give a dime of concern for that. Most Walgreens pharmacist (and now many other community pharmacists) will.
It is obvious that u sir , do not suffer from chronic pain!!! Yes Walgreens did put a cap on how large a script for oxy!!!!! My bf was using this pharmacy , and a couple of others on a monthly basis! 3 years ago ….if one pharmacy could not fill , you just moved to the next one down the road!!! Why would one wait till Walgreen’s decides to get certain meds in? It is the most UTTERLY RIDICULOUS THING I HAVE EVER SEEN IN MY ENTIRE LIFE!! WALGREEN WOULD not fill my bf scripts after the law suits or dea bs that Walgreens was battling a couple years ago!! They were filling his every month , then suddenly you couldn’t go to any Walgreen’s with out them being out of stock , not comfortable filling your script , not trusting of the prescribing doctors name because your doctors name doesn’t ring a bell or they’ve heard rumors about the doctor being a pill mill type of doctor!! He’s had one pharmacist at a grocery store or independent pharmacy say they didn’t have them in stock , and come back the next morning on a no pharmacy delivery day …..to have a different non lying pharmacist fill them!! Pharmacist are abusing their right to turn a patient away if they feel the need to! Its completely out of control!!! Lying right to your face because it the one opportunity for them to be able to “f… you I don’t have to fill your pain meds!!” I believe ….no I know some if not most are taking great pleasure out of abusing their authority!! I have heard every single lie from a to z!!! Eventually you do find a cool pharmacist , but it is extremely difficult!! And the reason he had to look for a new one , is because he was formerly a walgreens customer , and they stopped filling scripts for Oxycodone over the amount of #120….plus they stopped ” having them in stock!!” ( in other words lying)!!! There was a group of people , and a lady in charge going to the capital , and picketing for ” pain patients ” rights , a couple years back when the pill mill crack downs happened , and everything else hit the fan!!!Just so sick of these pharmacists not wanting to do their jobs!!! Because god only knows their job is just so tough ,;and 35$ an hour is just not enough pay to fill scripts of oxycodone!! The prescribing doctors , as well as their patients are following all the laws and guidelines , especially all the new precautions , but yet still the pharmacists are still playing their little games of “I don’t have to if I dont want to!” and the attitude of “what are you going to do about it?!” And they know the prescribed patient/ customer can’t do a damn think about it until our voices are heard in numbers!!! If something shoulet happen to my bf regular pharmacist , he wouldn’t know what to do??? Its an awful situation to be in when its your 29th day of meds , you drive to all the pharmacy’s in the heat in Sarasota , some in Bradenton , some at university!!! Pharmacist have carried their tiny bit of authority WAY TO FAR!!! MAYBE ONE DAY THE PHARMACISTS THAT ARE TURNING PEOPLE IN NEED AWAY WILL ONE DAY KNOW WHAT ITS LIKE ON THE OTHER SIDE OF THE SPECTRUM!!! KARMA IS A BITCH MR. OR MRS. LIAR!! THE SAME GOES FOR THE MORON WHO CALLS HIMSELF LOOKINGATMIRROR!!! BUT THEN AGAIN IT JUST WOULDN’T BE NORMAL WITH OUT AT LEAST ONE TROLL ON THIS POST , BECAUSE AFTER ALL , THERES ONE ON EVERY POST!!!
I COMPLETELY DISAGREE WITH YOU!!!! I am a chronic pain patient who also became an addict. I had a doctor give me Morphine, Percocet, Oxy, Vicodin for severe constant pain. When I tried to quit, I couldn’t do so without facing withdrawal, even by gradually reducing my dose. I was put on Suboxone to deal with it and have taken that for 3 years, and am now in the VERY PAINFUL process of reducing my dose and ultimately quitting. A lot of these comments remind me of how I spoke on opiates — long detailed posts that basically talk about how you are one of those “real, legitimate pain patients” unlike us nasty addicts out there. I’ve never stolen, never lied to anyone, and never taken illegal drugs. I just followed the doctor instructions, and here I am.
Some of you guys are still in the blissful pain pill high state, but you’re in for a crash landing when you have to quit.
By the way, I live in pain literally every single day (suboxone isn’t great for pain unlike what my doctor claimed). Pain doesn’t kill you. After taking almost every opiate, I’d take the pain over being an addict and being in this horrible situation I am. I have found that gentle exercise and a great diet actually goes a long way. Yes, even when you’re in pain. Everyone can do something. Especially if you can type long comments.
And oh yeah, pharmacists don’t have an easy job, I have seen enough people holding up pharmacies to steal their pain pills on the news.
*The above was not written by a pain patient.
I understand clearly why Walgreen’s are “controlling ” our prescriptions, but it’s ridiculous to let a patient run out of medicine! My latest issue was it was due to be filled in 12/24/19, I dropped it off on 12/23/19, then when asked if I could pick up by 11am, they advised me my 90 day GFD was due, and mentioned it hadn’t been done since August,,,,well why not? It’s now December, and it’s time to leave town, I explained my Doc will only be in till 3, she said regardless he’ll have to verify it.. He E-filed, and I’m bringing you the original as well!! Well of course my Doc was gone, and wasn’t returning till 12/30,which meant she would had made me be without medication 7 days! Needless to say, I came the next day, picked up my script, and took it too a pharmacy that filled it in 5 mins. They as well as Walgreen’s knew my doctor and told me a over-ride button could had been used due to the holidays at their discretion, but I reckon being a patient for 6 years, same doc, same pharmacy meant nothing! I also called my insurance, and was told that a pharmacy should never let me run out of my medication, since they could care less about me, I have no problem transferring all my medication to a new Pharmacy. I don’t believe it’s fair to treat everyone if they are a drug addict, and that’s exactly what y’all did….. Thanks, but No thanks!
Pain pill high state? We don’t get high, we get pain relief. Big difference. Right there you’ve shown you were taken pain meds to get high, not to get pain relief. You were abusing your medication. Many pain patients do not abuse their medication, to take it to get high, they take it for pain relief. This b.s. narrative anyone and everyone who has ever taken pain medication magically turns into a raving addict is our modern day reefer madness. Yes, some people abuse their medication. Yes, some people become addicted. Yes, some people have addiction issues. No, not everyone abuses their pain medication, takes it to get high and/or becomes an addict. Patients in pain don’t need Gestapo-like pharmacists playing pharma-cop. They need their prescriptions filled. The only thing they are accomplishing at Walgreen’s with their policy is helping to perpetuate the opiod crisis and increase the death rate.
Very well spoken for all of us that don’t get high from our medication!!! We actually use them to relieve our pain. Pain, that would make daily life and working, extremely difficult, if not impossible. Of course, we may be addicted, because we absolutely need our medication and some of us have been on them for so long. We have no choice. So, having to wait longer than our Dr. and insurance company says you can get them filled, because of a pharmacy, is absolutely criminal!
Walgreens just told me they are out and every other location was out. I detoxed in 2 days because my DR. had me in a state of withdraw / sick everyday for a year and a half. He is the only pain Dr. i ever had that is refusing to titrate every 6 or 8 months .
He is young and the young Drs are prejudiced and Really Stupid.
So when they finally gave me meds 5 days later, The pain was Unbearable ,but , now I was able to take a little bit more to stop the pain and the withdraw symptoms. I felt like A Human Being Finally after 18 months. I am going to try to convince him to follow CA. Law which says He Must Treat Me , with 10 spinal injuries , aggressively ! I just titrated mildly ! I Suddenly stopped pooping, I got an appetite, I started socializing, I started singing with the old folks Kareoke ( I was a singer/guitarist/keys,drums etc. I started p[laying again. I slept well, I tried to catch up on so Many things I let go ! It has been Wonderful . I bet you that the DR will want to put me right back into Under medication while pouting like a little spoiled bitch! I want to sue!
I will do whatever I have to to keep my life normal ,like the law says I have a right to! Go to the Attorney General site and file a complaint with the MBC Med Board of CA. Either they will help or they might just try to kill you! I’m not sure. There has to be a normal Dr or Judge. I am going to die in Pain . I’m 65 . I have maybe 5 or 10 years if they treat me right ! Maybe 1 or 2 if they keep this up! . Why do they get so arrogant and sadistic! Every Dr that I had before titrated as soon as I told them I’m feeling Yukky ! They were ALL Older , More Experienced, Wise Decent Doctors. I am horrified by these Young 30 ish Drs that think they know better than Anyone !
This guy is in his 40s and still Poorly trained , Prejudiced , and antagonistic, sneaky, writes for less and less! I am shocked that here in California I get treated like the Klan tortured me in Indiana.!
OK.. so you’re either a misguided do-gooder or in some way involved with Walgreens.
If you have a problem with bad Drs “running a pill mill”, go after them.
Don’t tell someone (me for example) suffering from chronic pain from Degenerative Disc Disease “we all have to pay a price for a few bad guys”.. easy to say. You’re not paying the price.
I’ve seen this “Good Faith Dispensing” check list.. it’s ridiculous and intrusive. A Pharmacist presumes he can over ride the treatment plan of my pain management Doctor?
In my case I was turned down for my regular prescription of 90 Vicodin and told “He had to complete a few steps that may take a few days” on the whim of a Pharmacist, because I stopped at a different Walgreens than usual because my usual Walgreens was crowded. He refused to even tell me what steps “he had to take”. Now because I got aggravated and left, the “refusal” is noted on my record, no other Walgreens will fill it and I will be reported to the DEA…… great right? Vicodin isn’t even on Walgreens list of pain meds which fall under their “GFD” guidelines…
I am a 58 yo Grandfather just trying to make it ONE MORE year at my job so I can retire and end the abuse that 40 years of my profession has put on my body. The meds are the only thing that allows me to keep going to that job everyday..
As of today I will never step foot in a Walgreens again, not for a gallon of milk or a bottle of ONE A DAY SILVER vitamins.
I refuse to deal with a company that passes on the punishment for their sins to folks with legitimate medical conditions, while telling them it’s for their own good.
Hello…I am profoundly affected by so much of what I have read here. I have had 4 cervical spinal fusions since I was 35 (turned 45 recently) , DDD, neuropathy , arthritis and need further lumbar fusions. I’ve become fearful (due to past results) of proceeding with lumbar surgeries, and I’m trying to hold out until newer techniques get approved by insurance or /and I cannot walk…I have had to stop working after second fusion, I have had to take pain medication since 2007 (I have always had a contract with pain management physician: random urinalysis, pill counts, same pharmacy—responsible policy I adhere to). My chain pharmacy suddenly did not have my medication starting 1/2015 . I’ll not go into the minutiae of excruciating humiliations I’ve experienced with pharmacists that I’ve never a non-compliant incident with—let’s say it’s been enlightening in the most horrible of ways. ( My doctor is in NJ, and I had moved to RI—because of the opiate abuse problems nationally (profound here) & due to Medicare, my primary and surgeon in RI told me I will not be able to get a pain management Dr. in RI—despite my perfect adherence over 8 years). I have to drive 250 miles monthly , which makes the pain even worse, and get the thrill of not being able to fill a rx I’ve for years. There is a patient database for opioid patients….in the majority of states…it takes a couple minutes to input a name , and both drs. & pharmacists can see which drs one has seen, what rxs filled, frequency of both, locations, etc. Between the monitoring of a legit Dr & making that database mandatory nationally, we —as compliant patients—should not be made to suffer more nor go untreated/maltreated. It sucks …..Sorry..I’m crying writing this…Sincerely, Kelly G.
Well said my friend ….well said!! I have the same thing you do!
WELL STATED SIR!
WALGREENS IS RESPONDING TO A DRUG PROBLEM THAT INVOLVES FEW OF THE LEGITIMATE CHRONIC PAIN PATIENTS.
RESPOSIBILITY LIES NOT ONLY ON PHARMACISTS, DOCTORS AND INSURERS BUT US, THE PATIENTS!
IF PATIENTS TAKE TIME TO COMMUNICATE WITH ALL INVOLVED IN THEIR HEALTH CARE FROM THE BEGINING, SO MANY OF THESE PROBLEMS CAN BE AVOIDED!
TAMPER RESISTANT OPIOID MEDS CAN DO A LOT TO HELP THE ENTIRE SYSTEM BUT IT’s NOT A PANACEA!
LETS FACE IT. DIVERSION IS THE PRIME CONCERN OF PHARMACISTS AND DOCTORS! TAMPER RESISTANCE LESSENS DEMAND AND ROBBERY RISK.
THE PATIENTS IN SOCIO-ECOMONICALLY DEPRESSED AREAS SUFFER THE MOST!
MAIL ORDER SUPPLY IS AN OPTION THAT SHOULD BE INVESTIGATED. IT HELPS ALL INDIVIDUALS INVOLVED.
I have no idea who you are and if you will even see this but your commentary is rude and accusatory. I noticed that you have asked Dr Fudin if he is associated with Purdue in anyway? Fascinating that you take this opportunity to grandstand and basically attack Dr Fudin for writing what he thinks on his own blog and you don’t even have the courage to leave your name on your comment. Who are you? Are you Andrew Kolodny? Perhaps Gary Mendell? Jane Ballentyne? Are you associated with PROP? Are you part of Phoenix House, Shatterproof, or maybe the Steve Rummler Hope Foundation? Are you affiliated with Indivior? Who are you associated with? We probably will never know; like I said, you didn’t even have the courage to state your name after making such outrageous statements. I am actually not surprised.
I found your response to be angry and accusatory. I am not sure how you can compare the inconvenience of driving through a DUI checkpoint to a person who has chronic pain having to suffer and pay the price for the people who choose to abuse drugs or try to fill fraudulent prescriptions. Funny since when you go through a DUI checkpoint you go through; you leave it behind. When you suffer from chronic pain the way that I do, you don’t get to drive away. I don’t get to go through a checkpoint and be inconvenienced and leave it in my rear view mirror. I get to live with it every day of my life but I guess in your eyes, that is just my bad luck as it’s my duty as an American citizen to have to give up my life, suffer and pay the price for someone else’s actions and malfeasance. How dare you tell Dr Fudin to change what he wrote in his blog. You aren’t required to read his blog. If you don’t like his blog then why don’t you read something else or better yet, start your own blog.
Why don’t you get your facts straight. The fact is that you sir are wrong. Less than 1% of chronic pain patients suffer from the disease of addiction but you will see a slight variation in the percentages depending on the article that you read. I have read anywhere between 0.6%-3%. Are you trying to say that 97%-99.4% of all chronic pain patients need to suffer because of people with addiction? I sir find that unreasonable and quite frankly, cruel.
Before I forget, since you are keen on having what you deem as incorrect statements corrected, let’s correct some of yours. First of all, the numbers that you quote about all these overdose deaths? Let’s speak the truth since that seems to be important to you. You left quite a bit out. Of all these deaths, the majority are not chronic pain patients who were pre-screened for addiction who are taking their LEGALLY PRESCRIBED prescriptions as directed, not mixing them with benzodiazepines, ETOH and other substances. These are not chronic pain patients who are doing what they are supposed to be doing. These numbers are comprised of people taking ILLEGALLY OBTAINED prescriptions and mixing them with ILLEGAL and ILLICIT drugs like heroin, fentanyl, cocaine, methamphetamine and other various substances such as benzodiazepines and ETOH. Notice how the CDC has never reported the number of deaths of chronic pain patients who are taking their legally prescribed opioid medications as directed and not mixing them with other drugs and ETOH. You know why this number isn’t shared with society? Probably because the number is so insignificant and so incredibly small that it would make people laugh and it wouldn’t support the agenda of Gary Mendell, Andrew Kolodny, PROP, Jane Ballentyne, the University of Washington, Indivior, Phoenix House, the Rummler Hope Foundation, the CDC, DEA, FDA, and whoever else stands to earn a buck off this fake “opioid crisis” that doesn’t even exist. I invite you to retract your statements.
Do you have a problem with chronic pain patients who are disabled or perhaps are so disadvantaged that they are receiving public benefits? If not, it sure seems like you are. You are talking about “our tax dollars” going to these people and how their prescriptions are “feeding addiction”. How dare you. I worked hard my whole short life until I became disabled at 36 due to a horrible auto-immune disease that destroyed me almost 10 years ago. Oh, did I happen to mention that it is excruciatingly painful and I require pain control and I take opiates? Should I have to apologize for this? Are you going to imply that I am selling my very needed medications because I am on disability so therefore I must be addicted and therefore am a criminal and selling my meds for money? Like I said, how dare you. Oh, and by the way, I sir pay taxes and my husband and I pay quite a bit so I don’t want to hear that I am a drain on society because I was unlucky enough to contract a horrible disease. I am college educated and I have a degree and now I am using my degree to advocate for people like myself who are suffering because of people like you who think that we should have to suffer for a societal problem. That it’s just too bad and that we should have to give up our lives because someone else chose to abuse drugs. That’s right, let’s not forget, it’s just like being inconvenienced at a DUI checkpoint, right?
What Walgreens is doing is wrong. Plain and simple. If pharmacists want to practice medicine then they should have gone to medical school and became a physician. Yes, pharmacists are valuable and their job is very much appreciated. They do save lives when they are doing their job which is monitoring for drug to drug interactions and it is important that they make sure prescriptions are valid which means, not forged. It is not their job to decide that someone’s diagnosis isn’t deserving of pain relief nor is it their job to profile patients and decide that they don’t like the way they look so they don’t get their prescription. It is their not their job to violate a patients privacy and get in their chart and start passing judgements on whether they think they are sick enough or injured enough to require pain relief; they are not God. It is not their place to cause undue suffering to an innocent, law-abiding pain patient and deny them a very needed, medically necessary prescription. Do you know what can happen to a patient who is dependent on opiate medication when they miss a dose? Oh, that’s right, you probably don’t care, after all, it’s their civic duty to suffer since other people decided to get high. Right.
Maybe you should research what you are pontificating about before you go out and make such outrageous statements. Maybe you should open your eyes to the injustice and discrimination that is being perpetrated on the chronically ill, elderly and disabled.
Thank you for your time.
Thank you for your well-written response and plea to stop the progressively worsening and outrageous marginalization of pain patients by government and health care providers.
“We all feel bad for every legitimate pain patient suffering because of this and we realize we don’t have a perfect system yet. Sometimes we all pay a price for a few bad guys in our society. When I have to go through a long traffic for a random DUI checkpoint on my way home after a long day at work and have to answer an officer whether I had anything to drink when I clearly haven’t tasted a drop of alcohol in my life, I don’t throw a fit on my blog.”
Having to deal with a stop at a check point when one does not consume alcohol is not even remotely the same as having to live in excruciating pain or experience withdrawal symptoms from pain medication (dependency is not the same as addiction) because an Eric Cartman, power-tripping pharmacist won’t fill a legitimate prescription for pain medication. A check-point is a nuisance, the latter is a far cry from being a nuisance. Ever have a root canal and without any anesthesia or drugs? Not even remotely similar, Your quote above speaks volumes and gets at the heart of another epidemic Walgreen’s is helping to create, that of leaving patients in excruciating pain and/or facing withdrawals (again, dependency is not addiction). It is for this reason I left Walgreen’s after being a lifelong customer, I encourage any and all others to do the same. Strike two, one more and it’s game over, Walgreen’s.
All this will accomplish is a steep incline of deaths from heroin bought on the street because there will no longer be another option. I also hope that these power hungry, greedy God complex having individuals end up on the other side of the situation. Karma is real and it will come for you.
Hi I understand they are worried about the misuse of prescriptions such as Oxycodone but walgreens is acting like the police for the dea because they got in trouble and it was part of their agreement with the dea but in their new role they are not helping but hurting patients I had always gone to the same Dr and same pharmacy for years they have a good relationship with my Dr but after years of filling my prescriptions for Oxycodone they suddenly said I did not meet their good faith policy this drug should not have been stopped the way it was like other drugs that can cause harm when stopped suddenly by refusing to fill my prescription they have caused me to suffer not only from pain but severe withdrals someone must be accountable for this
Thank you for listening
Ann M Lambertson
Amen!!!
First Walgreens shorted me on my morphine er so I ran out 4 days early. I called Aetna and asked if they would agree to let me fill my monthly Rx early and they said no. Aetna advised me to have my doctor write a script for a few pills and pay cash for them. When I went to Walgreens with this Rx, they refused to fill it because it was “early”.
One of the many little stunts they pull!!
I like Walgreens’ GFD Policy.
The problem starts with the questionable physicians and their questionable prescribing practices.
The pharmacies and pharmacists are forced to be the professionals to help curb drug abuse/addiction that these physicians promote.
I’ve got chronic pain too, they’re all a pain in the a** and make work difficult.
If you like those policies how about outlawing liquor. I personally don’t know a single drug addict but I sure have run into alcoholics throughout my many years.
Many of us live pain filled lives and are now being sacrificed on the theory that we are all addicts. That just is not true and I resent being forced to be a bedridden human being just because a bunch of bureaucrats in the government and at these pharmacy companies decide that my doctor who has known me for 20 years doesn’t know what is best for me.
Love ur comment!
I know more pill addicts than I know alcoholics. Thats a weird comparison.
Rules , regulations , and guidelines have made it almost impossible for those doctors to be in practice anymore!! We are past all that!! Thats pretty much been stomped out! Next!!! No
offense or direspect to u , but I’m sick of all the old excuses!! Its been two years since the dea brought the hammer down , and cleaned house…..its as good as its going to get! Ik i do my part with drug tests , pill counts , i.d. , doctor visit price increases!!! Now its time to access the situation and bullshit that we have suffered from it all ….its gone on long enough!!! No more excuses about drug addicts! From what I understand , theres going to be a law suit going on against those who are part of the problem …making it difficult on people that need this medicine!! This came from a good pharmacists mouth!!
l
A Doctor in our area was arrested for illegal prescribing –My Neurologist with the same last name prescribed me pain meds and they refused thinking it was the one arrested .
While there is indeed an epidemic of opiate abuse in this country, I’d like to humbly suggest that it is not the responsibility of a local pharmacist or their company to police the world, or solve the problem. Their job is to assist my Dr in carrying out prescribed treatment,period. As a chronic pain sufferer, I’ve been humiliated, judged and assigned a stigma while seeking treatment from a condition that has, at times, nearly caused my death.untreated chronic pain often leads to severe clinical depression which can cause suicide. Why should I have to suffer further in order to seek legitimate care and relief? Why should I have to defend myself to a stranger or convince them that my condition is legitimate?Walgreens is trying to over correct a problem they themselves created through poor business practices. Leave my treatment to my physician, leave the policing of the community to the police, and do your job within the law instead of making up your own under the guise of “saving the world from itself” or saving me from myself. Part of the problem is, people don’t know the laws governing their meds and they don’t know their rights as a patient or customer.they desperately need the medication, and often there b isn’t much of a window for figuring things out if there’s a snafu. Many pain docs are so strict, that by the time you get a refill, you’re about out. So the pharmacies have you as hostage and you feel like you have to do their dance…but you don’t.noone should tolerate being humiliated or having their intentions questioned by the company who benefits from their treatment. Complain loudly,vote with your feet. I’d also like to point out that if walgreens requires a large prescription be broken into 2 separate scripts, their daily “script count” increases, which makesit appear as if their business is growing.
Cathy,
Thanks for the comments. A very interesting article and Walgreens post is on the way in a few days. Keep your eyes out here because you’ll want yo comment. Regards, Dr. Jeff Fudin.
Thank you Dr.
Thank you for working to keep Walgreens and their “policy” for filling narcotic medications fresh! I feel that I have been mistreated by Walgreens. I have been coping with the pain from failed cervical surgery; it was found that 2 screws were broken but too dangerous to remove! I have been filling at Walgreen’s for more than ten years; and have a contract with my Dr. to fill only at Walgreen’s! The past 6 months I have found myself without my pain medication because the Walgreen’s have all told me that they did not have my medication! After 2 days without my medication this month; I went to ER. The first time, nothing was done for me, it was decided it would go against the pain contract I had signed! I went back the second time after 3 days without my medication and after the doctor heard my story that no one had my medication, she made a call to what I now know was a Walgreens across the street from the hospital. She told my friend to take the prescription across the street that she had confirmed the medication was there! My friend took my prescription over and they accepted it. My friend then came back to the hospital and picked me up and took me home. He told me my prescription would be ready in two hours and that he would come back and take me to the pharmacy in a couple hours. I was home for about 20 minutes and got a call from Walgreens that informed me that they had made an error; they did not have my medication! My friend came back and got me and we tried without success to get Walgreen to fill my script. I then had my friend take me to the hospital for the third time! After leaving the hospital the third time with 5 pills to hold me over till I could see my doctor or fill my prescription, I was greeted by the Sheriff department and taken to a psychiatric hospital; where they berated me on behalf of Walgreen’s!
What???!!! Are u serious? Wtf? What reason did the legally have to take u to a psychiatric place? Where were the cops at? Walgreens? You didn’t do anything wrong? Are u saying Walgreens called the cops on u? For what reason did walgreens have for cali the cops and saying you deserved this?
DR FUDIN.
WHEN I WAS A NEW PATIENT I HAD MANY OF THE CHRONICLED PROBLEMS.
I WENT TO MAIL ORDER 90 DAY SUPPLIES AND IT HAS MADE A WORLD OF DIFFERENCE!
PATIENTS MUST ESTABLISH MINIMAL CREDIBILITY. THERE ARE ABUSES BY PHARMACIES. GOING TO MAIL ORDER LESSENED MY SUPPLY ISSUES THAT I TOO EXPERIENCED ON THE 30 DAY RETAIL MERRY-GO-ROUND.
Hi all of these story’s sound like mine. I have been going to pain Managment since 2005 after a car accident . I had surgery to try to correct the problem but only made it worse. I have been using Walgreens as my home drug store since starting my pain meds . I did this for a reason so they would always have my history . I moved two hours away from my dr but kelp seeing him . I still used Walgreens I had my address changed ony drivers license and my dr put my new address on the perscription so everything was legal . Walgreen in Cheifland Florida has givens problems since day 1 they had one pharmacist that would feel it for me all the other ones who worked there would not fill it. They always said we are out of it or just we can’t fill it . I used one drug store company and one dr for this reason was so I wouldn’t have a problem but still I can’t gety meds so what can I do
Dr. Fudin, I’m thankful for keeping this on your radar. I have Arachnoiditis from a medical mistake 9 years ago and have been on the same dosage of pain meds for 5 or more years and with the same doctors for more than 5 years. Arachnoiditis has been described as “pain like you have cancer but you don’t get to die”
I never had problems getting my scripts filled at CVS until recently. All of a sudden they don’t have the meds so I have to go to sometimes 7 other pharmacies to find someone that has the meds in stock. This has effected ALL the pharmacies in my area … CVS, Wallgreens, Walmart, Target, Publix. Then I have to go thru additional strutanny because it’s a new pharmacy to me.
How come I never had problems getting my pain meds and now everyone is out of stock?
@Michelle: It’s most likely, that your pharmacies are suddenly “out of stock” due to a drug enforcement crackdown. I know first hand, when they check if a medication is stocked, they are also deciding if they want to fill your prescription. If for whatever reason, they are worried about filling your prescription, they simply say they’re out of stock. Occasionally there are legitimate medicine shortages, but they are corroborated by news reporting as they affect us nationwide.
So to wrap it all together, drug enforcement has negatively impacted your ability to access legitimate health care. Drug prohibition has many extreme consequences, and they affect non-abusing members of society. One that disgusts me intensely, the essential trust between pharmacist and patient has been shattered.
This “shortage” started happening to me in Sept 14. After 3 mths of panic( my pain level uncontrolled is 10, I pass out) on recommendation from my MD, switched to small neighborhood drugstore. Wouldn’t “shortage” affect them too? Not a problem 3 mths now. Walgreens broke the law, not us medical patients. They were abusing, pushing huge amts of drugs, caught & now treating us as the abusers? They can go to hell.
Right on sista! I cant believe how big and how long this problem is existing! We both have really bad backs , and each currently have our own very helpful , cool , and kind pharmacist’s that we go to every month…..what do we do when their not around?? The other pharmacist that works opposite days when mine is off will lie to my face every single time , just like my pharmacist said she would do when I first became a customer at cvs!!
For real!!!! This has been going on for a couple years now!!! I remember when it started , when their truly was a shortage , due to manufactures of the meds being shut down! But everything with all that has leveled off , yet pharmacist think we’re stupid enough to believe that no pain medicine came in on their shipment they get in 2 times a week like every other pharmacy!! Again every thing is back to normal , and the chaos when pill mills where being busted , doctors were being investigated , and manufacturers where being shut down has calmed down quite a bit , but yet the pharmacy’s think the people trying to get pain medicine are stupid , and don’t know our current situation!!! I would really like to teach them a lesson! But I have a feeling shit is going to hit
the fan soon , especially with men like Dr. FUDIN THANK YOU!!!!!!!!!!!!!! YOU ARE AWESOME!!!!! 🙂 🙂 🙂
Walgreens’ implementation of its GFD policy and the subsequent risks to the public is a pharmacy profession issue. It is deeply concerning that no State Board of Pharmacy, or pharmacy professional organization has deemed that Walgreens is participating in unprofessional conduct. The ethics of this speaks to the Oath of the Pharmacist that states, “A pharmacist acts with honesty and integrity in professional relationships “ and “A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner”(4). In Virginia, the State Board of Pharmacy ruled that Walgreens’ actions appeard to violate no rules or regulations of that state. In New Mexico, the State Board of Pharmacy (NMBOP) defines unprofessional conduct as, “Participation in a plan or agreement which compromises the quality or extent of professional services, or facilities at the expense of public health or welfare”(5). By this very definition it seems clear that Walgreens is engaging in unprofessional activity in New Mexico; just by reading this regulation, the issue seems cut and dry. In an effort to have the GFD policy investigated as engaging in unprofessonal conduct, New Mexico Congress-woman, Michelle Lujan Grisham has sent a letter to the NMBOP outlining her concerns and requesting that the GFD policy be put on hold until these concerns can be addressed. (6).
Bullshit!!!!! Have u ever read the pharmacist code of ethics , some times can be found on the drive through window!! There is a statement that pertains to their oath not to knowingly let their customers suffer if they can help it from happening! Something similiar to that!
imiliar to
I also have experienced the same ordeal from walgreens. I broke my back in 2008, had spinal fusion three levels, with decompression . Now i see a pain doctor on a monhtly basis. I have been on same medication and have only been with walgreens. I luved in Ny, when i broke my back . I moved to CT and always stayed with walgreens. Now for past two months i have been given the run around and been told they dont have. They had me sit there for 4 hrs to fill rx,because they had to fill out some paper and speak to dr. I dont have a problem with that but when you have a pt that has been there on same med for almost 5 yrs. I dont think it should be a problem. I will definately be looking for new pharmacy.
Dear Dr. Jeff,
THANK YOU for passing along this amazing post!
I was recently affected by this new, unexplained, vague and rude GFD policy at a Walgreens in Southern CA. I write a blog about my life as a nurse and a spine patient with chronic pain. I just published a post about this very negative Walgreens experience, and the comments that came in from other patients (all in various states) told of the same hardships with filling thier long-prescribed, regular medications at Walgreens . Each one is leaving WG, and telling family & friends to change Pharmacies.
I have a well-documented medical history going back to a rollover MVA in 1976. Multiple Thoracic spine surgeries, fusions, knee surgeries and much more. I am a credible and compliant patient. I do not Pharmacy hop or Doctor shop, I create long-lasting relationships with any part of my care. I have been a Walgreens Pharmacy customer for over a decade.
I submitted some refills via the convenient email and text alerts they offer, and was called by the refilling Walgreens Pharmacist, saying something was wrong with one of my meds. The med in question? Carisoprodol. Soma has been a necessary tool in the management of my severe muscle spasms. I have filled it every month at Walgreens. Same prescribing doctor, no changes.
On the phone this Pharmacist informed me (by reading off a script) that they had implemented a new policy, and in all good faith, he ‘could not’ fill it at “This or any other Walgreens”. He hadn’t even SEEN me! They are refusing a refill a medication (filled at Walgreens 30 days prior) simply because of internal issues, threat of job loss, or whatever it is they are doing.
One of your commenters wrote, “Also, in regards to “prescribing by omission” or adverse events from withdrawal, you seem to be under the impression that the Rx is being ripped up and tossed away. In reality, the Rx is given back to patient and they are free to take it somewhere else. Odds are, most legitimate patients are well established with a pharmacy, and will not be refused medication.”
The fact that this Pharmacist prescribed by omission, that I had to go to another pharmacy I am not familiar with, is messing with my rights as a California Pain Patient. I have dealt with holdups in fills for years, I have learned to keep calm and fight for my health. However, this is going too far. I have now established my business at another Pharmacy, and I refuse to enter a Walgreens, or spend one buck there.
We all have the option to CHOOSE our Pharmacy. No drug-seeker here, just a really angry EX customer of a corporation that doesn’t give a hoot about the patients they serve.
Or those they refuse to serve.
Shauna,
My pleasure. Thank you for your comments and sharing your experience. Dr. Ernie Dole really deserves the thanks for putting together all the facts. I’ll let him know about your comments. Best of luck! Dr. Jeff Fudin
Ms Harrelson, I agree with you!! When I state “prescribing by omission” it is really just that. In the same manner that a provider writes a prescrption for a specific medication, for a specific outcome. When the Walgreens pharmacist refuses to fill your prescription, not based on any state or federal law, but by a corporate internal policy that was borne out of corporate self interest, due to corporate greed, that pharmacist stops the filling of that prescription, and the intended outcome is not reached. In essence they have written a prescription to stop the one by your provider. Therefore the intended outcome is never reached, and the negative effects of that are felt by the patient. I find it interesting that when I have discussed this with Walgreens administration, that their pharmacists have a “corresponding accountability” that goes along with the “Corresponding Responsibility” that Walgreens hangs their hat on for the need for the GFD policy, Walgreens administration has no answer to this questions.
However you do have some recourse. The California Medical Society has on their web page a section where problems with Walgreens can be registered. Also you might consider logging a formal complaint with the California Board of Pharmacy. Once a complaint is logged in, it will be investigated. So if you wished you could get all your friends & family that have problems with Walgreens not only to vote with your dollars, but also to register complaints with the California Boards of Medicine and Phamracy. Additionally, all your providers that are having problems with Walgreens can do the same. If every person that was impacted by this GFD did only that, there would be a critical mass large enough to hold Walgreens accountable for their actions, and to change the implementation of the GFD policy.
In fact if every person in every state just took the action listed above their would be significant accountability for Walgreens and significant change. And it is only a little bit of effort that would go a long, long way.
Walgreen’s pharmacists are now making the decisions of doctors. This blog does not include what happened to me and at least 4 other people I know of. After filling my prescriptions with Walgreens (preferred pharmacy with my Part D plan) for three years, last month the pharmacy manager advised me that THIS WAS THE LAST TIME SHE WOULD BE ABLE TO FILL MY SCRIPTS. She said, “I have spoken with your doctor and have determined that you DO NOT FIT THE CRITERIA REQUIRED BY THE DEA. These medications are for people who are dying and you are not dying.” She went on to tell me that I would be better served getting physical therapy rather than pain medicine?!?!?!
Fortunately after visiting and/or calling at least 40 pharmacies, I was able to find a small business pharmacy that was willing to fill my prescriptions this month.
Rhonda,
Unfortunately as stated repeatedly your experience is not alone. However I am working to collect as many incidents against WalGreen’s in regards to pain medications and Pharmacies. I am on Facebook, please send you and your 4 friend’s stories (must be written by individual, parent, guardian, etc…) in a private message. I will be submitting ton a project to collaborate at hearings in DC against this issue.
Thank you and again I am sorry for all of your frustrations,
Stephanie
Walgreens’ implementation of its GFD policy and the subsequent risks to the public is a pharmacy profession issue. It is deeply concerning that no State Board of Pharmacy, or pharmacy professional organization has deemed that Walgreens is participating in unprofessional conduct. The ethics of this speaks to the Oath of the Pharmacist that states, “A pharmacist acts with honesty and integrity in professional relationships “ and “A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner”(4). In Virginia, the State Board of Pharmacy ruled that Walgreens’ actions appeard to violate no rules or regulations of that state. In New Mexico, the State Board of Pharmacy (NMBOP) defines unprofessional conduct as, “Participation in a plan or agreement which compromises the quality or extent of professional services, or facilities at the expense of public health or welfare”(5). By this very definition it seems clear that Walgreens is engaging in unprofessional activity in New Mexico; just by reading this regulation, the issue seems cut and dry. In an effort to have the GFD policy investigated as engaging in unprofessonal conduct, New Mexico Congress-woman, Michelle Lujan Grisham has sent a letter to the NMBOP outlining her concerns and requesting that the GFD policy be put on hold until these concerns can be addressed. (6).
Walgreens’ implementation of its GFD policy and the subsequent risks to the public is a pharmacy profession issue. It is deeply concerning that no State Board of Pharmacy, or pharmacy professional organization has deemed that Walgreens is participating in unprofessional conduct. The ethics of this speaks to the Oath of the Pharmacist that states, “A pharmacist acts with honesty and integrity in professional relationships “ and “A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner”(4). In Virginia, the State Board of Pharmacy ruled that Walgreens’ actions appeard to violate no rules or regulations of that state. In New Mexico, the State Board of Pharmacy (NMBOP) defines unprofessional conduct as, “Participation in a plan or agreement which compromises the quality or extent of professional services, or facilities at the expense of public health or welfare”(5). By this very definition it seems clear that Walgreens is engaging in unprofessional activity in New Mexico; just by reading this regulation, the issue seems cut and dry. In an effort to have the GFD policy investigated as engaging in unprofessonal conduct, New Mexico Congress-woman, Michelle Lujan Grisham has sent a letter to the NMBOP outlining her concerns and requesting that the GFD policy be put on hold until these concerns can be addressed. (6).
Dr. Jeff,
I appreciate that your article advocates patient focus, and shows concern for the legitimate medical need for pain medication. So I ask…
What, then, is the solution to this problem? It sounds like the DEA is forcing Walgreens hand. Reduce the amount of opiates dispensed, or risk losing DEA licenses and having distribution centers shut down. If a pharmacy is shut down by DEA, then it cannot dispense any controlled substances, and will therefore lead to an even larger delay in the filling of patient prescriptions, and an overall shortage of supply and patient access. Clearly, this is the end game if pharmacies continue dispensing at their current rate since DEA has no problem shutting them down. (Which begs the question, what gives DEA the right to decide how much control substance prescriptions is too much for a pharmacy to dispense)
Cardinal health in Florida was once temporarily suspended, and as a result, they now limit the amount of controls sent to pharmacies, again hindering the availability of drug. Much like Walgreens, their hand is being forced.
I am a retail, non-Walgreens, pharmacist, so I can sympathize. I know many pharmacists among all chains. Walgreens pharmacists have informed me their number one reasons for refusing rx’s (mostly oxycodone 30mg) is due to lack of valid ID from patient (required by law in many states), doctor shopping, pharmacy hopping, and lack of opiate history. They also refuse prescriptions by doctors who are clearly running pill mills (accept cash only, prescribe nothing but large quantities of oxy/lortab/BZDs/soma, have patients from all over the city coming to them). Are these not legitimate reasons for refusing these prescriptions?
On the flip side, while non-Walgreens pharmacies don’t have an official policy in place, I know for a fact that pharmacists are refusing to fill a majority of oxycodone prescriptions coming their way. Many are using the less controversial “we don’t have it in stock” method (even though they do, in an effort to avoid confrontation). Do you prefer this method to Rx refusal?
Yes, there are going to be flaws in this. Just like any other policy. Bad prescriptions are going to slip through the cracks, and good prescriptions are going to get refused. But in the end, the hope is that this will result in less abuse, less street use, less addiction and less overdoses.
This is a real issue that needs to be addressed. The DEA is placing pharmacies and distributors on the front lines. In the retail environment, I’m willing to argue that more than half of all prescriptions for oxycodone are not for legitimate medical purpose. Anyone who thinks otherwise, is very naive and has not experienced the real world. The numbers alone don’t lie. If every prescription was legitimate, then why are the streets flooded with prescription medications? I read one article which claimed something to the effect that, in 2011, Florida alone dispensed more oxycodone than all other states combined. Are people in Florida in 49 times the pain of all other states?
A friend who works for Walgreens informed me there is no part of their policy which limits the quantity of medication per prescription. This may be a rogue employee making their own rules. Also, in regards to “prescribing by omission” or adverse events from withdrawal, you seem to be under the impression that the Rx is being ripped up and tossed away. In reality, the Rx is given back to patient and they are free to take it somewhere else. Odds are, most legitimate patients are well established with a pharmacy, and will not be refused medication.
It is very easy for a pharmacy to take a prescription, enter it, fill it and sell it. This is a process that takes less than 10 minutes. There isn’t a pharmacist out there who doesn’t want the process to be this simple on all prescriptions. However, there’s a bigger issue at hand. Rather than scrutinize pharmacies and distribution centers (which are already getting heat from the other side ie. DEA), why not propose a better solution?
Dan,
Thank you for taking the time to write this from the persepctive of a community pharmacist. I’m going to ask Ernie Dole to repond to your thoughts. I’m curious to learn what state you in. I must disagree at least on some level with your statement “Odds are, most legitimate patients are well established with a pharmacy, and will not be refused medication”. Simply see the blogs herein Dancing to the Pharmacy Crawl for Opioids at https://paindr.com/?p=1348 and Kentucky’s Pharmacy Crawl at https://paindr.com/?p=1672.
Your post is correct and does a good job of pointing out the different layers and sides to this issue. I feel that the Walgreens GFD policy and its implementation can be summarized in 3 points:
1. First do no harm.
The first principle of any healthcare profession is do no harm. Walgreens GFD is the antithesis of this principle. Instead the Walgreens’ GFD policy places patients at risk by delaying the dispensing of a patient’s opiate prescription and/or enforces that only #120 doses will be dispensed, no matter the amount of pain medication that was written for the patient.
2. Who defines the profession of pharmacy?
The Business Dictionary.com defines a profession as: Occupation, practice, or vocation requiring mastery of a complex set of knowledge and skills through formal education and/or practical experience. Every organized profession (accounting, law, medicine, etc.) is governed by its respective professional body. In pharmacy that body is the state’s Board of Pharmacy (BOP). It is the job of the BOP to protect the public. Therefore it should be the BOP setting the standard for our profession and communicating to business what is allowed, not the other way around.
3. The integrity of our words
a. The statements made in the Oath of a Pharmacist have meaning and we stand by those words as a profession and sanction Walgreen’s actions; or those statements in our profession’s Oath have no meaning and corporate self-interest defines our profession
b. The NMBOP regulation, New Mexico Code of Regulations. 16.19.4.7, “Participation in a plan or agreement which compromises the quality or extent of professional services, or facilities at the expense of public health or welfare” as unprofessional activity, the BOP stands by its societal charge to protect the public, and Walgreen’s GFD is deemed unprofessional activity and sanctioned; or the words are empty and the will of a corporation over rides the regulations of a BOP
c. Our state and national professional organization’s policies on patient care, the pharmacist’s role in patient care and safety have significance and therefore advocating for provider status in our profession is valid. Or the words are hollow. As a profession it is impossible to both stand that pharmacists should be recognized as providers and not take action to sanction Walgreen’ and its GFD policy
When the niceties of political correctness are removed, it is clear that Walgreen’s GFD policy was borne out of corporate self-preservation that is a direct result of corporate greed. Walgreen’s public relations machine had to use misinformation in implementing the GFD policy because the truth was to damaging. If Walgreens is truly a “patient safety first” organization, than this policy would have been put in place before BILLIONS of doses of oxycodone were sold in Florida causing patient harm. Walgreens GFD policy has components of state and federal regulations that guide the dispensing of controlled medication, however stating that it is “trail-blazing” and implemented for patient care, is the height of hypocrisy and corporate spin. The rigid enforcement of the GFD by Walgreens is because the corporation is much more worried about fulfilling requirements promised to the DEA, than patient safety. The principle of “First do no harm”, is at best a distant second with Walgreens corporate administration. After all, the DEA did not fine Walgreens $80 billion dollars because they were doing the right thing!
Here’s what’s driving Walgreen’s on their new personal opioid policy.
Walgreens to pay $80 million for oxycodone violations
Money usually is a reason why companies change policy.
I find this absolutely chilling that Walgreen’s would be fined so heavily for violations of the Controlled Substance Act. I am not aware of another chain being fined like this in the past, and am aware that Chain Pharmacies take great care with minimizing regulatory violations. I wonder how Walgreen’s practices varied from other chains? I haven’t heard that any individual pharmacist is being prosecuted or fined for dispensing practices.
I have long held that the use of Opiates to treat pain is legitimate, and personally have no issue with this practice. The laws become increasingly restrictive in pharmacy practice, along with the number of prescriptions that are suspect, and personal danger to the dispensing pharmacist. As much as you want to provide pharmaceutical care to patients, pharmacists must do this within the applicable law.
Good luck with this.
Regards,
Cynthia A. Obus, PharmD
If you please search the Walgreens situation you will find some compelling evidence against Walgreens . They are being so heavily fined because they were pushing oxycodone sales . There oxycodone sales more than quadrupled . Bulletins from corporate to pharmacists to allow prescriptions to go through to up oxycodone sales were found . Google and research the situation . Walgreens created their own problem .
I already have a better solution. Let’s let Darwinism go ahead and kick in. If these moronic junkies don’t have the sense to avoid killing themselves by overdose, then they obviously do not suffer from true chronic non-cancer pain. Let one of them spend a night in a truly pain-wracked body, in tears, begging God to kill you because there is no escape from the pain without medication and death would be oh, so much easier. i think. But I am a survivor-I don’t want to leave my family just because I cannot bear it one more second-even as I try to pull a belt tighter high up on my thigh, because maybe if there is little to no circulation, I won’t be able to feel the pain as much… Please know, regardless of the known legitimacy of our doctors, there will always be a few fabulous fakers who make it through and get meds even though they wouldn’t know true pain if it sodomized them on the street corner. I say, give the junkies all they want-restrict nothing from anyone. It will allow a goodly number of life-ending or better still, life-changing events. The number of people seeking medicine just to get high should drop radically as should the numbers of their “likely to drug-seek offspring.”
Thusly, our solution. The number of controlled substances sought, obtained, diverted and abused drops though maybe only slowly, but now, at least true pain patients will have their needs met and their lives enriched rather than the care and concern being diverted to the junkies and leaving us to suffer, let them do what they will and society will improve for it eventually. Currently, we have the whole system backwards. Worry and protect the junkie from himself, let the true pain patient suffer- WTF?
‘
I have a better solution – people need there meds to stay out of the er. So give the stupid medication so We can function or just not scream in agony. There’s use answer.
walgreens has been the only pharmacy to request records and diagnosis codes for patients. no other pharmacy has requested such information. They have told me it’s the DEA’s new policy. Funny, I didn’t realize the CVS, Rite-Aid, etc. have been negligent in following DEA’s new policy, or perhaps it’s walgreens who is blaming the DEA.
Dr. Tarr: Very enlightening! No, the rest of the pharmacy world is not breaking the law. Next time Walgreens tells you it’s a new FDA Regulation, I’d ask them to site the law and fax you a copy. There is no such new regulation, and CVS / Rite-Aid are not liable for non-compliance. Thank you for sharing!
Actually, in different parts of the country, a variety of local and national chain drugstores have implemented similar policies, and therefore this is not a ‘Walgreens-only’ problem. The true problem is the opiate epidemic that this country is facing. As stated above, this is a multiple layer issue.
My guess is that it would be enormously difficult for the DEA to prove, on a case by case basis, that their registrant prescribers are not “issuing controlled substance prescriptions for legitimate medical purposes acting in the usual course of his professional practice”. And so by taking a different approach to more strictly enforce regulation of their other registrants, the pharmacies, they will at least begin to narrow the channels to opiates.
Once again, pharmacists are on the ‘frontlines’ of policing healthcare and rogue prescribers. What are the Medical Boards doing? In my opinion, not nearly enough.
Hello Jeff,
We’ve tried to post 2 (two) items of information, however your blog is not working &/or someone is blocking your information…perhaps WALGREENS?!
Thanks.
Bob, Nobody is blocking anything. I asked you for clarification via email about who your represent.
The DEA does not and cannot make policy like that. This is Walgreens own internal policy called the Good Faith Dispensing (GFD) policy, but Walgreens pharmacists are blaming it on the DEA, among other reasons. Check with your state Board of Pharmacy (BOP) and ask them if the DEA can make policy such as you describe. Also check your state’s BOP webpage and look for what they define as unprofessional conduct. If there is any regulation that says something like, “Parties planning to decrease quality of care…”, then submit a complaint to your state’s BOP asking that they investigate Walgreens for unprofessional conduct. Submit any injury due to Walgreen’s unilateral actions to your BOP. Also check w/ your state’s Medical Association and see if they are taking any action.
You are quite correct, the DEA does not make this policy, but what the DEA has done is enforce the policy of the “corresponding responsibility” of the pharmacist. http://deachronicles.quarles.com/2013/08/a-pharmacists-obligation-corresponding-responsibility-and-red-flags-of-diversion/ After Walgreens shelled out $80 million for their pharmacists’ failure to uphold their corresponding duty due to questionable narcotic prescription being dispensed, I can most certainly understand a change in their policy and their apprehension when dealing with schedule II substance. Understand something, if a pharmacy (non-mailorder) loses their DEA permit, they might as well close their doors, they are done. No community retail pharmacy can exist without a controlled and dangerous substance permit. Without it, a pharmacy cannot even buy or dispense a valium, or even prometh with codeine cough syrup, and folks, with all the competition out there, there are no pharmacy owners I know that are ready to take that chance to put their years of schooling and their livelihood on the line to fill a questionable prescription. What is questionable? Read the link I posted above. Big red flags for DEA are patients taking the “Holy Trinity,” Oxycodone, Methadone, and Alprazolam in tandum. Such patients receive high quantities of substance, and for DEA, big quantities = DIVERSION. Diversion is when a patient figures out they can get by with taking only 6 oxycodone 30mg a day instead of 8, and decide to sell the tablets left over for a tidy profit~say $1.00 a mg or $30 bucks a pill. Most pharmacies are lucky to make 5% over their cost on these substances because the insurance companies have put the big squeeze into their “take it or leave it” contracts. So, let’s get back to the “Holy Trinity.” Pharmacists truly need to question why a patient needs 180 oxycodone 30mg, 84 Methadone 10mg, and 90 Alprazolam 2mg.Both Oxycodone and Methadone are short-acting opioids (though some physicians believe Methadone to be long-acting because of its long half-life). The DEA is actively monitoring all patients nationwide taking this combination and pharmacists are in tune. It makes much more sense to treat a chronic pain patient with an extended release pain killer such as oxycontin (which has become invariably crush and snort-proof), or Morphine ER. Alas, the big money making insurance companies do not want to pay for effective combinations because Methadone is so cheap. Methadone is also dangerous. Again, because of its long half-life, the difference between a legitimate, controlled dose, and a lethal one is sometimes razor thin. Methadone slows down breathing and affects heart rhythm. Though Methadone accounts for only 2% of narcotic prescriptions written in this country, it is directly attributable to over 30% of over-dose related deaths. As far as Walgreens being more worried about making money than their patients’ welfare, I do not agree. They have lost 10’s of millions of dollars due to their new policies (did someone mention early on that Walgreens makes more money if they “split” prescriptions? This cannot be done with a schedule II substance as it is against federal law!). Though I generally hate the chains, I applaud Walgreens actions. They have helped turn the tide of diversion in this country, are protecting the safety and welfare of their patients, and have shown regard for the dignity and licenses of the professionals that work for them. If you do not care for their policies, find yourself another drug store that will fill for you before DEA does. Sorry to be so blunt, it’s just the way it is.
i frequently get requests from walgreens pharmacy for records and diagnosis codes to be able to fill patient’s prescriptions for narcotic medication. They’ve informed me that it’s being required by DEA if more than80-100mg of oxycodone/day
No, the DEA is not requiring any such information; that is untrue information provided by Walgreens’ pharmacists. It is unclear to me if the pharmacists are being told by Walgreen administration to make statements. What is clear is that after reading Walgreens GFD policy, that the pharmacists are threatened w/ loss of their job if they do not follow the GFD policy. Please see my previous post w/ possible action you could take. I would also make sure and contact your state Medical Society to see if they are taking any action.
Thank you for posting this, Jeff. I had been sending my scripts through mail-order (CVS), every 90 days. My Dr. was permitted to write the script at the 75 day mark, giving the CVS mail-order time to fill the script and ship as to not have me as the patient ever be without these life saving medications.
Interestingly, soon after the PROP proposition was sent to the FDA, every time my script was filled, my Dr. was called prior to the filling, which caused a delay. I was never notified that CVS was calling my doctor, but when I had not received my meds when expected, I called CVS and was told that they were awaiting as response from my physician. I then had to call my Dr. to alert his office to the fact that amongst the 1000’s of fax’s his office receives per day, that he needs to respond to CVS that his Computer generated, secure script was indeed ment fore me?
The last script I have ever sent to CVS was in Feb. of this year. It was sent the 28th and by the 11th of March, I had no notification of shipment. Needless to say I was becoming alittle stressed. I called my Dr. office and they said they had not been contacted. CVS stated that the script was “in process” On the 15th, the online follow-up of the # given to the script that they admit receiving, now states, “cancelled”, with no futher explaination!!! Now, I am 2 days of being without any meds and in a full panic! I have been lowering my doses so that i would at least have something. My BP is sky-high. BC/BS can only tell me that CVS cancelled the script due to “Protocal” Walgreen’s similar reasoning is called “Internal Critria”
I made many calls to CVS, BC/BS. No one had any answers as to why my script was “cancelled”, nor why my Dr. was not called as in the past, nor why I wasn’t notified! With this being a 90 day supply of an opiod, they had to know that with out this drug, I was going to go into withdrawal and at my age and other health conditions which if they would have taken the time to read them “on file”, the filling Phamacist literally had my life in his/her hands. The script was returned by regular mail, with no explaination. I had it filled 30 days after it was written, locally, paying 5X the amount of mail order.
One month later, I receive a letter from “patient quality assurance program”, wanting my Dr. to send them all of my patient history for the past 12 months so that they can assess if I have not been denied my policy privilages. Now, I do not know who sent the letter, nor have I been sucessful in locating the sender. I feel either the insurance company or CVS is now trying to protect themselves..
This is really all about “the money” Everyone would like Chronic Pain Patients off the system as we are a drag upon it. As the babyboomers get older and live longer , something will have to be done with the young ones that Choose to Abuse, and support the ones in Chronice pain who had no choice.
Linda
I’ve spoken with chronic pain patients who say that Walgreens will not fill their generic pain medicine scripts because they are not abuse proof. Has anyone experienced Walgreens trying to force them to buy expensive name brand medicines because of the generics are not abuse proof? The DEA and other groups are working hard to ban generic pain medicines that lack abuse proof chemicals ( which is pretty much all the generics because there are only two or three abuse proof chemical patents and they are proprietary).
I won’t shop at Walgreens anymore for anything, especially not from the pharmacy. I used to get my prescription meds from them, including opiates because I am a chronic pain patient. Things went fine for almost 2 years, then suddenly the same store I’d been using consistently every month started the “we don’t have these” foolishness. I’d already gone through two “interviews” with two pharmacy mgrs at that store – explaining my medical conditions and what other therapies I’ve tried, etc. I spend 3 months running around to 4 or 5 of their stores hoping, praying someone would fill, went through more sneers, unnecessary questions from their techs, until one day I went into a Publix after going to 6 pharmacies who “were out” of my meds. I didn’t expect any luck at Publix but I was pleasantly surprised. I was treated kindly, and told my rx’s would be ready in 30 min! And each month since they have treated me with the same kindness, and if they haven’t had a med in stock they ordered it, and it was in no more than 2 days later! Bye Walgreens! I too hope you end up in court, you deserve it for the way you have treated us, your FORMER customers! Thank you very much for posting this article…
Public is an awesome store. Clean and out for the customer not the bs everyone else is pulling.
On my fifth hour at Walgreens waiting on my Rx. Wow what service!,
One more thing,,,,,,,,,Sorry, I am an Arachnoiditis Patient. And, with spell check, they still don’t recognize “Arachnoiditis” as a correct spelling. hahaha. Sometimes, and I mean this from the bottom of my heart. Sometimes I just think, “Don’t take the drugs anymore. Just DON’T”. I tried it once, and I thought I was going to die. I don’t want to go out this way. NOT IN PAIN!! Thanks Dr. Jeff………………Herb Neeland
Herb, As I was reading your post, I was getting so upset! Fist let me tell you how sorry I am that you to have become a victim of greed, and now have to suffer because some shot jockey or greedy surgeon ruined you. And to add insult to injury the hassle getting meds filled. Meds you need because the pain of arachnoiditis has few equals. I to have Arachnoiditis, and have many problems getting my meds filled. If doctors would go back to the oath and stop caring about money then Arachnoiditis will become a rare and orphan disease ….. Please visit our website and discover what we are doing to put an end to the worst iatrogenic disease known, and don’t give up, one day the FDA will pull their heads out and realize that tens of thousands of people have a pain as bad as end stage cancer, all this without the benefit of death…. Thanks Dr Fudin for your relentless work trying to preserve the one thing that we need to get by!!
http://www.endarachnow.org
Hi Dr. Jeff……Whenever I see and article about Walgreens, or one of their policy’s or just walking into the place, my throat tightens up. Why? Well, there is always a hassle. When I was injured in “99”, and my wife and I moved back to Arkansas, I began my journey with Walgreens. When I had my surgery, and after the promised ONE DAY in the hospital, (ended up staying eight days), I was sent to a Physiatrist. I was given Opioids. Well, I didn’t know about these things. I was an RN, but had never taken these kinds of drugs except the time I had a ruptured disc in my neck. Even then, it was a hassle. BUT, NOTHING LIKE THE HASSLE trying to get two different opiods, that I knew I would probably be taking the REST OF MY LIFE.
I tightened up, my throat would nearly close, I would stutter at the drug counter. I would have tears in my eyes. I actually cried, two times, while just trying to explain the prescriptions. EXPLAIN? Why would I have to explain? Well, I was actually, not knowing, apologizing for having to take medications. That’s how it was. I was approached once by a pharmacy tech, she looked at my prescription, and tossed it at me. TOSSED IT!!!! She said, “FRESH OUT”. It was Oxycontin. I was taking the generic. I walked over to the place where you give the Pharmacist the script. I told her what had happened. The Pharmacist said, “Yes sir, we have this drug.” BUT, they had just made it where you had to have a tripple copy.” The Doc was not aware, and it was just a brand new policy. I just cried. A six foot four, 230lb RN, who had been an athlete all his life, just stood their and cried.
I pick up my wife’s blood pressure meds. I don’t have to deal with Walgreens, personally. If I pick up my wife’s meds, there is ALWAYS A HASSLE. ALWAYS. It’s never smooth, the ins. is RIGHT, but there is always something………The last time I had to go to Walgreens personally, with a script for the damned Oxycontin, which I DON’T take anymore, it has been replaced with another opioid, I had to confront another, self indulged, know everything tech. She was mean to me. She sneered, so help me. She knew she could complicate my complicated life with just one sentence. “What do you take these for?” WHAT??!! What do I take these for? I was humiliated. So, that was the last time. I get my meds from a Warehouse in Fla. Now. Is it a hassle? Dear God, I don’t even want to talk about it. BUT, it’s heads above, “WALGREENS”. As far as I’m concerned, I hope they get pulled into court and never get out!!!! Sorry for the burst of anger, but my throat is tightening……….Thanks Dr. Jeff,,,,,,Herb Neeland,,,,doc
Hello. Filling opioid medicine Rx is always a challenge. I use the Walgreens in Lubbock, Texas to fill my opioid medicines each month. The only time I’ve had a problem is if Walgreens did not have enough opioid to fill my 180 pill count. To prevent this I give the Pharmacist a weeks notice so he can have enough pills to fill my Rx. I was told that Walgreens stop filling dilaudid, methadone and demerol. When I was prescribed Oxycontin; when filled at WalMart the pills made me very nausea. But filling Oxycontin at Walgreens did not upset my stomach.
My lesson learned was: if you have severe side effects from a Rx try filling the Rx at another pharmacy that buys their Rx from a different manufacturer. The inactive ingredients vary and these might be causing your side effects, and not the opioid.
Outstanding! Thank you so much for this blog. So much great info. I use the VA and a pharmacy that is locally owned and we do not have that problem. However, I did run into that problem at Walgreen filling my daughter’s meds after surgery. I will pass this on to all of my friends. Again Thank You
Outstanding blog post. Needed to be said. In our free-market society, the best way to get the attention of corporations like Walgreens is at the cash register. Walgreens exists for one purpose and one purpose only – to make money for shareholders.
Competing pharmacies (Are you listening CVS?) should see this as an opportunity.
James Patrick Murphy, MD, MMM
TWITTER @jamespmurphymd
I’ve never had any luck with Walgreens filling any type of opioid medication for me. There was a Walgreens within walking distance from my apartment yet they refuse to fill any opioid medication but will fill the Testosterone Gel, Antibiotics etc. I see their TV commercials saying we will be your personal pharmacist and will assist you in any way we can. I will never walk in a Walgreens again.
I found pharmacies that are owned by a individual are nice like a Good Neighbor pharmacy.
Its hard enough finding a compassionate Pain Specialist that will prescribe to us that suffer from chronic pain and a insult to have a pharmacy say we cant help you.
I’m really getting fed up with this thing about people that suffer from chronic pain getting treated like a common criminal. We didn’t ask for this type life and I hate taking these type medications. But if I stop taking the medication I use for ongoing never ending chronic pain I will not be able to even write this to all of you.
Wishing you all a pain free day,
Mark S. Barletta
It’s such a roller coaster ride. My local, longtime CVS has been spotty, at best, in their fulfilling of my prescriptions. They recently gave as the reason that that they could not fill as “You have not filled here in a while”. Well, duh! You won’t fill for me so I am forced to go elsewhere. I am getting so tired of a year and a half of doing this pharmacy crawl every single month. I am getting so tired of the anger of overworked and frustrated pharmacists and technicians. I just want to be able to get my prescription filled. I wish I “could” find a pharmacy that will guarantee they will fill for me but that seems to be an elusive dream. So, I continue the crawl.
Walgreens was one of the 8 pharmacies that deny me access to my medications when I first moved to South Florida, and ever since then, I have not stepped into a Walgreens again! As consumers we need to send Walgreens, CVS and every other pharmacy that mistreat us because of our conditions, a message, and that message has to say loud and clear, that we will NOT spend any of our dollars in your stores, if you don’t treat us fairly! I found a great pharmacy in Miami that does fill my scripts, and they get ALL of my business! When we as consumers start taking our dollars somewhere else, maybe then the Walgreens of the world will start treating us with respect!
Millie your a better person than I am, I have been in that situation, when I started pain meds the pharmacist walking away(smh) said were trying to get you off drugs, now was asked if I was going to get refills because they have no more, pharmacist was told yes to order,