Today I received an e-mail from a chronic pain patient who has been very active on our blog and friend to Facebook’s Paindr. I was both moved and bothered by the e-mail she sent regarding my pharmacist colleagues that chose a career in Community Pharmacy (with Walgreens) versus a Clinical Career track, although I recognize that all of us have an important role in direct patient care regardless of the titles we hold.
As many of you know, there was a recent Guest Blog post, Is Walgreens Opiate Policy Deceptive?, by Dr. Ernest Dole on this very topic of Walgreens’ pharmacist refusal to fill opioid prescriptions. As a heads-up and some foreshadowing, Dr. Dole and I will be publishing a guest commentary in Drug Topics on the recent statement by AMA physician Dr. Sterling to pharmacists, “Don’t Call Us We’ll Call you”, a preposterous expectation that would no doubt adversely affect patient care for many reasons.
The e-mail below asks me two specific questions;
1. Do retail pharmacists attend yearly seminars and such, and would this topic possibly be addressed at those seminars? Yes, there is mandatory continuing education requirement for all pharmacists, but there is no specific requirement that the education be for analgesic therapy.
2. Could talks with Walgreens be initiated by PROMPT to try to educate and maybe see what the problem is? I’m sure our countrywide PROMPT members would be delighted to work with Walgreens or any other group to teach and promote education specific to pain therapeutics. Many of them are significantly involved with teaching already.
Much of this turmoil is the end result of a recent “Dear Provider” Letter sent from Walgreens Corporation to prescribers that may be viewed HERE and HERE.
PLEASE FEEL FREE TO SHARE YOUR COMMENTS!
Ms. Maston writes…
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Dr. Fudin,
I hope you are well. Today I ran across another news article, this time from Georgia, where doctors are complaining that Walgreens is refusing to fill their prescriptions for pain medications. I’m well aware of what has happened in regards to Walgreens and the DEA, as I have been following this from the beginning.http://www.wsbtv.com/news/
The thing that really stands out to me is that Walgreens keeps claiming that they are leaving the choice to fill or refuse to fill totally up to the pharmacist’s discretion. I know that you can’t personally speak for every pharmacist, and I don’t expect you to, but I’m wondering what your take on this is, since patients are being denied these medications in record numbers now. Do retail pharmacists attend yearly seminars and such, and would this topic possibly be addressed at those seminars, or could talks with Walgreens be initiated by PROMPT to try to educate and maybe see what the problem is?
I worked in retail pharmacy for several years, and I know that these pharmacists have to follow corporate procedures, and a lot of times those procedures are more focused on risk management than what is best for the people they serve, and rather than what actually makes sense. They are trying to cover their behinds because they know they are being watched very closely. I can’t help but wonder if there are also threats being made to the pharmacists behind the scenes.
The numbers of people who are being denied their prescriptions by Walgreens pharmacists are staggering across the country. Anyone can look at this situation and see that there has to be more going on than just “leaving it to the pharmacist’s discretion.” Unless Walgreens is just going to stop filling opioid medications completely, in which case, they should announce that to the general public instead of sending thousands upon thousands of people across the country on wild goose chases to get their legitimate prescriptions filled. I can’t imagine that that would be good for their bottom line either.
Whatever the deal is, I have several patients that have been denied pain medications by Walgreens pharmacists. I have also personally been denied pain medications by Walgreens in the past. I am advising all of my patients not to use Walgreens any more. Maybe once they lose enough money, the “discretionary views” of these pharmacists will suddenly change. I don’t know, but I do know that what’s going on is not right, and that there seems to be a very real need for education here. Thanks for your time, and I hope you have a wonderful weekend.
Sincerely,
Mary Maston
MSK Advocate
Ms. Maston suffers from a rare, congenital birth defect, Medullary Sponge Kidney or MSK. She is dedicated to raising general public and medical professional awareness about this painful, life altering disease, and to generating new research and treatment options that could help fellow patients cope with the associated medical and social problems.
I live in Upstate New York and Walgreens here is disgustingly rude. I read that they can fill opiates up to 2/3 days early and they make me wait until the day and the hour that I picked up my meds last month. These pharmacists and techs lie and think it’s funny. I have been a chronic pain patient for 15 yrs. I feel humiliated and degraded after talking to the pharmacist and techs. They are just one accident or health issue away from having to take pain meds and how will they like being treated like a druggie? They are really playing Russian roulette with our lives!
Report then to the NYS Board of Education department of Pharmacy at http://www.op.nysed.gov/opd/complain.htm
Alright today I’ve decided to detox myself and if I bottom out well, that will just have to be. I’ve had it!
I am a Paramedic/Firefighter have been over 22 years. I had a heating pad burn to my left flank that somehow got infected with MRSA and of course it became necrotizing fasiitis. It required multiple surgeries and ended with my left flank being striped down to my inter coastal muscles and rib bones, I had a wound vac and was in the hospital for over 5 months. Home health after that and eventually was able to return to work missing an 8″ x 3″ x 2″ deep piece of back strap basically. My job is a demanding and physical one. But, I instruct as well as work on the trucks and air, so as a single parent I did my part and went back to work.
Now you may wonder why a heating pad? Well I had been involved in an MVA that I could not avoid, I was hit head on in traffic, while I was traveling at 45mph and the other vehicle was traveling at approximately 65 mph. I had 3 disks that were giving me grief, but I was working and going to physical therapy at the time, but the heating pad malfunctioned. I fell asleep and woke up with a small burn to both sides of my back, but thankfully only one side became infected.
The medications that it took to keep the nerve endings from trying to each across a great expanse that they would never be able to reach again were much higher in the beginning and I have taken myself off these meds before. But, now at almost 52, I find that all the wear and tear of years of lifting and moving patients in and out of the ambulance, in and out of tight areas, and getting them free of multiple other issues has indeed left me a worn out back. I am all of 5’2″ and when I started weighted 92lbs, now about 180lbs(No one ever believes this they usually guess about 140lbs but I know 180lbs).
I am tired and the constant pain medications have worn my body down.These medications ruin our teeth, bones, digestive tract, cardiology system, sight, sex drive, they rob us of most of what makes us enjoy life to the fullest, all just to dull the ever present pain they don’t stop it they just maintain it at a level that we can function at. To look at me you would never imagine that I take 10mg, 20mg, 10mg of Methadone each day, and 15mg of Roxicodone On top of that yesterday was the last straw with the judgmental Pharmacy System, that I intend on taking. It is so bad that I am sending this letter so if I do not make it thru the withdrawal at home my husband can bring it to the news and maybe help someone else in the same plight.
We had a Pharmacy that worked well with our Pain Management Doctor’s in town QVL that was Awesome but due to federal regulations and other issues that I do not understand they went out of business. The Staff there were kind, knowledgable, and friendly. They knew we were not all dopers out looking to wreck the world…… and they were the 1st to point out if there was some reason that you should try this intend or maybe this would be better, or well you get the picture. The day that the Pharmacist told me that they were closing he came from behind the locked door to hug me good-bye. We had become friends over the years exchanging stories about patients and medications.
That was 3 months ago now. It has been a nightmare since. CVS is closest to the Pain Management Office – “No we don’t have enough to fill that script and maybe you should consider getting off of those meds anyway!” >>> I kid you not! The very first time I tried to fill the script.
Next I tried Walgreens, I had to wait in line, then when it was my turn the Pharmacist wasn’t in and wouldn’t be in for a day or so and the tech didn’t think they had those types of meds and well, I could come back in a few days. I asked if she could call the other Walgreens for me and see if they had the medications and she said that she could not, but I could do that myself. I said “Mam they will not tell just anyone their supplies of narcotics, or they would be open to more armed robberies. I don’t feel well, and do not wish to travel to 12 stores and be judged by 12 clerks at each site for my pain meds.” She basically said “Well thats your problem, I can’t do it here.”
I went to Fred’s they refused to fill them because they don’t fill big time Narcs. Then I went to a local Pharmacy that will remain nameless that did fill the Oxycodone 15mg only instead of 60 only 40 pills made it to the bottle, this had never happened to me before I learnt and important lesson that day count your meds in front of the person that fills them prior to leaving.(my Pain Management Dr explained how this sometimes is how meds get sold twice) Then I had to go to Walmart, over 30 miles away to get the Methadone to get that script filled, and they just barely had enough,
So, you will be judged. You are guilty by association no matter what. I wish I could say I look like a thug, but I do not. I am usually quiet and would give anyone the shirt off my back if they needed it. But this problem is so horrible, so deeply rooted in society, and so insane. Pain management can be abused yes, are there people out there on meds that should not be, yes. Are there unscrupulous Doctors and clinics out there just mudding up the water and making things bad for the rest of us YES.
But, we are all not just sitting around waiting to get our scripts filled to go sell them. Some of us, are using them as directed to function, and be an active member of society. I’ve come off the meds in the past, I know I can do it again. But, I know that nothing kept my pain controlled as well as what I am taking now. I also know that I am very ill and these same medications will be driving the nails into my coffin, if I hadn’t already given my body to science. I have SVT & Bradycardia with a Reveal Implanted monitor in me now and heart rates that range from 28 – 289 bpm, CHF and chest pain. I have a hiatal hernia with esophageal spincter rupture that needs to be repaired soon, with horrible reflux and GERD. I have I have complicated migraines, and disk problems in my lower back including recurrent Tarvlo Cysts in the same areas. Bakers cysts to my bilateral knees and well the lists could go on and on.
But I want to live, work, play with my grandchildren, teach EMS and respond to Fire and EMS calls. I have been Paramedic of the year twice and Rookie of the year once. I am committed to what I do and to my family.
But I have constant pain, I am getting off the meds because, its a judgmental issue, because its an unfair bias, because these scripts are seen as a junkie with a needle in the arm, smoking a pipe, snorting it, selling it; instead of the working person, I am, trying to stay, a functioning portion of society.
I hope my next 2 weeks go by quickly and better than the last time I did this. I do not expect that though, I do pray for strength,
I’m shocked that Walmart would fill it for you!
I hear u. I’m 62 years old and have had several big surgeries.c I am on Tylenol 3, permately. By my ortho Dr. But today went to see my urologists for several repeats of stones and surgeries. I am fighting it again, with severe pain, so he put me on Percocet. My point I’d, last year cvs called my ortho Dr, and told him that my urologists gave me a script of Percocet, so my ortho Dr. Called me and said are u getting both meds now. I had to explain my self to him like I was a child. I was so pissed. And I felt like cvs,you had no business calling any of my dr.s. Tylenol does not help for kidney stones. Assoles
God bless you, but withdrawal cab truly kill you. Please take care if yourself. I know pain medication has many side effects but being in horrible pain is no quality of life.,I was humiliated yesterday also, and now I finally found out why my prescriptions are only partially filled for the last month’s,and how they are lying to me and the trucks haven’t brought them and they are on back order. I am 65 years old, and not a drug seeker. I truly have horrible pain from a drunk driver in a head on collision. He was going the wrong way at 65 miles an hour on a highway. I hope these pharmacy people are never treated this way or suffer in pain in their life. Thank you for your letter, and feel better
My husband has had 2 spinal fusions. The 1st one was in 1975 at the age of 18, he was paralized, then had the fusion. Then rehab for quite a few months at Spain Rehab in Birmingham. When I met him in 1985, he had minor ocassional pain. An ibuprofin, or a little rest was all he needed. Even with that fusion, He was the strongest man I ever met. He worked as a millright and had no problems picking up 200 lb. items .We had a beautiful, life. He was almost more active than I could stand. It was the beach, saltwater fishing, weekend trips, antique stores, dinner out, …you name it, we did it. Then he went to a hospital for a stomach problem and fell. The hospital kept him there for 4 weeks without a diagnosis, then suddenly he needed another fusion. (then covered up the fall in their records!!!) The first one was C4-5, and this one was for C5-6. When he woke up, he said to me, “Oh my God, something is SO wrong.” Finally 2 years later, after a suicide attempt, we found a Nuerologist to help. (his surgeon had never actually touched him again, saying he was just fine and all in his head!) he has Permanent spinal cord and nerve damage. Then we also found his coccyx bone had broken and grew back together backwards. Trying to make a long story shorter….we certainly lost out beautiful life along with everything we had. Homeless in a tent with 3 cats in 28 degree weather. Renting crappy rooms when I lost my job. And really?….not a lot of hope for a great future. My day now is filled with just trying to keep him comfortable. It is heart wrenching watching the one you love suffer so much. It has been 12 years now that he has struggled. He always says “Tomorrow….we ARE going to the beach.” He wants SO BADLY to have some kind of life. But tomorrow comes and he says….”I don’t feel like it.” With all that not bad enough, now he has this added enormous stress. Will they close down my Dr. ? ( We live in Florida) Will I be able to get pain relief meds this month? He was a patient of Walgreens, (the same one) for TEN years. They were always so friendly. Untill a year ago last May . First we went to the Dr. and She cut one of his medications in HALF because she said the pharmacy’s now have a ‘guideline’ from the DEA and they will not fill more than that. (She did NOT want to do it) WOW. But then we went to his normally friendly pharmacy and the lady that helped us every month for so many years….was so RUDE. So UGLY. SO MEAN. She said “We don’t have these, I don’t know when we will have them… if ever”……My heart sank because I had heard the horror stories. but he had been ok untill then. She did not refer us to another pharmacy or give us any suggestions. Really, there was NO NEED for her to be like that. We would have understood her, EVEN if she HAD been pleasant. So…the Pharmacy Crawl began. ( I don’t know what patients do that don’t have anyone to help them, It’s hard enough for my husband to go to the Dr once a month, and then to ONE pharmacy…he is exausted and in so much pain) Since they won’t tell you on the phone if they have it or not, you must drive from pharmacy to pharmacy to pharmacy. First, we went to other Walgreens since he had used them for so long. (We figure they enjoyed about FIFTY THOUSAND of his Medicare dollars over the years)…but no. Either “we don’t have these” OR “we don’t feel comfortable filling these”. So the next day it was to CVS’s and more of the same. The next day? Anywhere we could find. We finally found a new Mom and Pop type pharmacy to fill them. And she said. “Don’t worry, we will make sure he gets his medications EVERY month.” But then 3 months later, SHE said, I must have his Dr. cut this medication in half. (remember they had already cut it in half once) That was a blow. He had just decided that he wanted to do some water exersizes offered at a pool at one of the parks…to try to build up some muscle and stamina. He couldn’t do that now. Then 2 months later she said she could no longer fill the extended release medication for him. She said ( I MUST keep my controlled substance sales less than 15%, and that one costs SO much) or (we can’t get it from the warehouse) So we tried to fill that elsewhere, including his Medicare part D mail order. They lied to him for 2 months and then finally said, they don’t like his Dr. and will not fill it. (CVS Caremark) One of the reasons they had said they would not fill it was because they needed to talk to his Dr. I went TO the Dr. office and sat WITH the dr. while she talked to them. The next morning they STILL told me they needed to talk to the dr. When I told them they were mistaken, that I was with her when they talked, is when they suddenly did not like her and would never fill it. WHY had they lied to us so long? Now he has to take Morphine (WHY is THAT BETTER??) instead of the Oxycontin. This makes him sleep about 20 hours a day. You know…..2 years ago, even when there was no problem with pharmacies that I knew of, our life was a nightmare. Always struggling financially. living in a cramped space. Can we afford the power bill this month? car insurance? Along with those worries, is trying to keep him comfortable. And trying to keep him from getting so bored. He is already a worry wart to begin with, so I TRY to keep him calm. But with this added stress about the Doctor and the medication…..It’s almost more than EITHER of us can take. What do you say to your loved one when they ask you “WHY is this happening to me? I’m a good person, I don’t deserve this???” And you know it’s true. He is the sweetest man…..EVER. And most people would not treat their DOG the way he has been treated. It makes me want to scream some days, and cry others. This is CRUEL and INHUMANE treatment of sick and disabled people and I cannot….CANNOT believe that this is happening in OUR society. The United States of America. Suddenly I feel like I live in some kind of fascist government. Something needs to change. This is SO wrong on SO many levels.
I am in tears after reading this. This has gone too far. People who live with pain EVERY SINGLE DAY do NOT deserve to take the brunt of corporate borne greed. I am speechless. Thank you again, Dr. Fudin, for continuing to bring awareness to this insensitive issue caused by Walgreens own internal problems. I am tired of fighting for my rights as a pain patient. Writing about it helped over the past nearly 6 years, but in the end, I am still undermedicated, judged, treated like a drug addict and I am just plain tired.
Shauna,
Hang in there. Thanks for the comments. I have a major article coming out that lambastes Walgreens for their “Good Faith Dispensing Policy”. Keep an eye out here as it will be out any day. Things are happening in the background…have faith.
Dr Fudin this is my first time on this site .Me and my wife live in Pennsylvania and we are both on medicare social security disability benefits and have non curable disabilities.I have had crps and other back and neck problems and my wife has fibro along with a ilio inguinal nerve problem due to her surgeon nicking her ilio during fibroid surgery.Pain for both is unbearable but we had a doctor who prescribed us narcotic pain meds which gave us somewhat of a life.We had seen him for 20 years ,exchanged christmas cards and gifts and when he moved from location to location he implored us to come with him to his new location.2 wweks ago he told us he no longer would be our doctor ,he gave us our last prescription for our pain meds and basically said he is done treating us for our pain and basically to bad.He treated us like crap.Up until we started seeing him 20 years ago we didnt even know what a narcotic was.How can he get away with this.Is there ant place where we can complain about his treatment so noone else can be harmed.He gave us a death sentence because we will never be able to find a doctor to prescribe the medicines he has prescribed to us over a 20 year period.He has me taking 80 mg of oxcycontin 4 pills a day and 5 mg oxcy ir 3 times a day.He has my wife on 4mg of dilaudid 4 pills a day and fentanyl patch 25 mcg’s every 2 .5 days.He said we need to get these meds from our primary even though we never ever used or discussed pain issues with our primaries and our primaries didn’t refer us to him in the first place.His secretary went to some seminar and he now thinks everyone is a liar and noone has legitimate pain.He is a disgrace to let a 3 hour seminar ruin a 20 year great relationship with us .We never lied to him,took our medicine any way but the way he told us,never called in to get our meds prescriptions early and never picked up our pain meds early from the pharmacy.He stated many times over the 20 years how we were the perfect model of what patients should be and told us he was our doctor until he retired and would give us advance notice so we could find a new pain doctor with his help.When he dropped us he didn’t even give us a recomendation on someone to go to to continue treatment.This is horrible and there has to be a nedical board to complain to because this is patient abandonement and will cause us harm if not death trying to quit these meds by ourselves without a doctors help.What recourse if any do we have.Sorry about the spelling bt i am in pain as i write this and hope you understand.Thank you in advance Dr.Fudin.
Justin,
First step is to speak with your primary care providers.
KRATOM. When the doctors and pharmacist fail us we must go to kratom or marijuana oil. Sad but people in pain are desperate and may turn to heroin because it is only thing they have heard of…DON’T DO IT! Try the pot or kratom before suicide or heroin, please. Also non prescription PEA is good too but it is pricey.. Sometimes I left Walgreens wanting to smack someone. Intractable pain patients are depressed and grumpy enough without being treated like a sub-human by someone who does not realize that MY prescription costs pays her salary so technically she should be thanking me.
Here’s the latest…
Backlash Against Walgreen’s New Painkiller Crackdown
I am afraid to share my name as things seem to be difficult enough for me as it is. I have been monitoring my monthly visits to Walgreen’s and today marks the end of MANY years as a customer there. Just tracking back through my emails I can see it has been since 2005 but possibly even longer I have used them as my pharmacy. Many know me by name, including the manager. They used to be an outgoing and friendly group of people that I never hesitated to call with questions and completely trusted them with my medications. They now treat me very differently and will no even make eye contact with me. A few months ago this started with them asking (rather sheepishly) to see my ID, I said no problem and did my best to make light of it so they would not feel uncomfortable. Then in June I happened to go in a day early due to school schedule for my grandson. I was asked to come back the next day and I said that would not be okay as I drive 40 miles round trip to get there and back. I am on fixed income and that just does not work. I go to my Doctor every four weeks and after that go the pick up prescriptions and run errands.. They KNOW all of this by the way. So they agreed to fill it. Same thing happened in July and August. In July they actually called me over the intercom, my whole name, and when I got back to the counter asked me if I could come back the next day. August the same thing only I waited to find out if they were going to ask me to wait till the next day, which they did. Each time they filled all medications. Today I went to get my medications and the tech seemed stressed out, was waving around a piece of paper she said she need to fill out for me to get my meds, when I asked her what it was she said it was a nationwide thing she needed to do for pain meds. I told her if there was a problems I would just take my prescription elsewhere. Then she said hold on I need to ask the pharmacist what day we can fill these for you, they told me they could not be filled until Thursday, the 5th. Even though my doctor had today’s date, the 3rd of September. I asked her for my prescription and told her I would be moving all of my families prescriptions to another pharmacy. I have been with the same doctor for years, abide by all rules and do not abuse the system. I have Fibromyalgia and herniated discs back and neck. I have always been in full compliance with my doctor as far as trying other meds to find alternatives for pain management. After lots of trial and error it was obvious SSRI’s and other meds made me worse not better. Also should note my dose for ALL medications is the same today as it was 8 years ago. I have found these meds helpful, in other words they work for me. There was a time when I could not even get out of bed for weeks, months at a time and now the only time I am in bed is to sleep (unless I have a severe flare). What I want to know is what can we do? Thank you.
You can no longer fill schedule II meds early: meaning; you must count 30 days or however many days the supply is for and go back on the day the script would run out. Even if the doc writes it early he is assuming you are not going in early. Some place will fill a day or two early but with all this stuff going down I don’t temp it. I’ve filled my meds this way for years.
Its not just Walgreens. Since I live in GA as well I thought I would share. I went to fill my methadone Rx at a grocery store chain recently and there was a new pharmacist there filling in. He told me that they don’t fill this med there. Having been a regular customer of theirs for about 3 years getting the same medication at the same dose I was a bit surprised. Fortunately the tech came and told him who I was and then the pharmacist told me he was sorry and that the head pharmacist had told him about me and that it was ok for me to fill there. I was told that I am the only person who can fill methadone at this particular pharmacy. I feel privileged to be able to avoid the pharmacy crawl that so many patients must face each month, but at the same time feel a little bit guilty as well.
I would hate to be someone newly diagnosed and/or just starting out needing opiate pain medications in this climate of discrimination. When I moved to Savannah in 2010 I was turned down at least a dozen times trying to fill my methadone Rx. Kroger told me it was fine over the phone. I came and dropped off my prescriptions and did some shopping. When I came to pick them up the pharmacist who was so helpful earlier told me he just didn’t feel ‘comfortable’ filling the methadone but that he had all my other prescriptions ready for me (about 5 or 6 others). I told him he might as well put those back too as I’m not going to give them any of my business if they wont fill ALL of them. He did. I was lucky to find another Harveys pharmacy, the same chain I had been using before moving to Savannah and I had them transferred there. The pharmacist there told me they would have no problem filling the Rx since I was a regular at their chain store prior to moving.. Unfortunately it is a 40 minute drive one way! This was in Dec 2010. The pain management doctor I see is located in a major hospital complex in Jacksonville FL and is about as far from a pill mill as you can get yet if I was not a ‘regular’ already I am afraid my options would be severely limited. I try to fill my Rx while at the hospital in the hospital pharmacy whenever I can but my appt dates don’t always line up w/ the dates needed to fill my Rx. Used to be you could fill a few days early and then wait a few days longer the next time to fill but this convenience is now not only frowned upon but not allowed anymore by either the doctor or the hospital pharmacy unless it is one day early! This policy changed a few months ago.
One would think that with most states now having the Rx monitoring programs established that doctors and pharmacists could stem the tide of bogus and excessive prescriptions. Add to this the fact that most all patients at pain clinics must submit to costly drug screens and pill counts, at mine now they even call my pharmacy each time to find out the date I filled my Rx. I’ve been a ‘problem free’ patient there for over 3 years! Also they upped the drug screen to every 60 days for patients receiving methadone or oxycodone. It used to be 2-3 x a year random. Worried about false positives as I take omeprazole and Sudafed and they just changed to a test using an oral swab stick I asked if positives will be retested like they were before with urinalysis. The doctor told me that it was so rare they wouldn’t bother but I would be give another test! Shocking to say the least.
The DEA is lazy and misguided. Instead of relying on law enforcement investigative techniques they are using the same strategy as used for illegal substances, that of trying to slow the drugs at the source ie the distributors and the pharmacies. While this may be a good strategy to use on illegal narcotics organizations this is the wrong card to play when dealing w/ a complex and delicate situation such as the one concerning prescription drug abuse. This obviously affects legitimate patients along with the druggies. This strategy must be ok w/ the current administration though or it wouldn’t be happening and that is a sad state of affairs. I am afraid it is only going to get worse. With all the problems patients are having now I can’t imagine how much worse it will get if the label changes on opioids and the rescheduling of hydrocodone are allowed to occur by the FDA.
Thank you doctor Fudin and PROMPT for taking the time to run this blog and for having the conviction to stick up for patients like myself who’s quality of life is helped by the use of opioid pain medications. Also Mary I applaud your work in advocating for patients with chronic pain. Thank you for sharing your story and experiences.
I have been following this blog for awhile now but this is my first post. I am positive for ANA and anti-RNP antibodies found only in those w/ either SLE(lupus) or MCTD (mixed connective tissue disease).
I also have biopsy proven sarcoidosis affecting pulmonary, autonomic nervous system, GI tract, joints, skin, and muscle tissue. PM tools include-TENS unit, occipital nerve blocks, depo-medrol joint injects, Euflexxa (knee),exercises, and oral medications.
*I find it ironic that at a time when states are legalizing marijuana for RECREATIONAL use, those with chronic incurable disease states are being denied proven medications that relieve their suffering (sometimes w/in the same states, Washington).
All medications have risk and one must weigh those risks against the benefits thereof. Admonitions about safety issues should be for enabling chronic pain patients to use opioid medications more safely rather than to justify depriving these medications from those who need them. For many patients, including those with addictive tendencies, opioid medications are the only ones that help for chronic pain. The answer is to develop smarter programs that address these individuals needs for balance in the use of these medications, not to treat them as drug addicts. I have yet to see AA-type programs that treat these individuals specifically, which is necessary because abstinence therefrom is not an option. And certainly the DEA and other law enforcement need to get out of the business of medical practice, for which they are not trained.
Stephen, you make some good points. Keep in mind, when talking about risk- We live in a risk averse society today. People want government to pad every sharp corner and protect them from every possible risk imaginable-even from themselves. The media parrots stories about celebrities dying from “abusing prescription drugs”, without mentioning the person was mixing multiple drugs, street drugs, and/or alcohol. Responsible opiate patients are not junkies, nor do they abuse their medications. There’s the key-responsible. Why worry about being responsible when the government can tell us what we can and can’t do?
It’s ironic-the government “cracks down” on pain management, under the guise of protecting people, while having absolutely no concern for the same people who suffer from chronic pain.
As far as the DEA- they’ve lost the “war on [street] drugs”, and they know it, so they turned their focus on prescription drugs. Remember, the primary goal of any bureaucracy is self-perpetuation. They have to justify their existence, their often egregious police tactics, and their bloated budget.
I’m in the last stages of a rare and fatal genetic collagen vascular disease, Vascular Ehlers-Danlos Syndrome ( type IV) . The disease causes pain in all connective tissues; skin, tendons, muscles, joints, and also causes vascular pain which can’t be treated with NSAIDs (causes breathing problems) or Prednisone (it’s like pouring acid in my veins), therefore my treatment regimen is limited. It also causes cardiac issues (but was told by my cardiologist NEVER to allow an ER doctor to administer nitroglycerin for chest pain), and periodic ANS dysautonomia, which causes bowel paralysis, extremely low blood pressure and occasional stroke level high BPs, crushing fatigue, and cardiac Q & T wave abnormalities., If that weren’t enough, I also have ankylosing spondylitis. I live in Florida and there are no MDs in this state who treat VEDS in adults. Because the disease is so complicated, and because no doctors treat it, I had hoped to live long enough to be an EDS advocate. However, the more I learn about what our government is doing to severely restrict pain medicines for people without cancer (but whose pain can be on par with end stage cancer) the less optimistic I am about being able to advocate for others.
My pain doctor is not in private practice; he is affiliated with a hospital. The last 2 times we went to Walgreens, where the pharmacist knows me and knows my disease is fatal, we were told we could not get our scripts filled as they didn’t have enough and when we asked when they planned to order more, the techs were nothing if not contradictory. One told me a week, and I told them to ask the pharmacist as he knows my case. He shortened the order date so I was able to get it just in time. But as time went on, after 6 months in bed with debilitating pain, my conservative doctor said he could physicallly see the downward spiral. He asked who treated my VEDS, and I said no one. He said, “No one?” I explained there are no physicians in Florida who treat adults with VEDS. My husband suggested to the doctor it might be time for me to have Hospice care, and the doctor suggested we wait and see if an increase in dosage might give me a quality of life (it was zero). I told him that our major concern was getting the two prescriptions filled as we go to Walgreens. He said, “Have them call me.” As if Walgreens pharmacists will? If Dr. Fudin hadn’t told us about the government’s plans to short the Walgreen’s Distribution plant on opiates, I wouldn’t have been able to inform my doctor this might be a problem.
This time Walgreens refused to fill one Rx, but filled the other. The tech knows my situation but this time our faithful pharmacist would not agree to fill the Rx in question, which totally shocked us. It took 3 days and 6 pharmacies to finally find another Walgreens that filled it. In the future, we plan to use a pharmacy recommended by my pain physician. He said, “If you fill it here, you will have no problem.” I hope he’s right, but since I live in Florida, it seems unlikely he is.
It’s sad that Walgreens is 6 miles away and the recommended pharmacy is a 2 hour round trip. One thing is for sure, if you are dying from a disease that no one treats in the state of Florida, and you’re too sick to go out of state (the closest doctor I know of is in Maryland), having multiple aneurysms per day (as any blood vessel can blow anywhere in the body at any time), and know this month’s medicines could be my last because of the issues I’m reading about here, it’s important to tell my story. Dr. Fudin, being able to speak intelligently to my doctor about these issues with opiates is because you gave me the information. I can’t thank you enough!
I want to thank everyone for you participation on the blog topic! My goodness, I think we have broken some records for the length of some comments from medical providers and patients. This collaboration is exactly what we need in order to make sure the regulatory agencies and lawmakers see what is happening from several perspectives. PROP members (See https://paindr.com/two-chairs-for-prompt/) have been parading patients and family members all over the country to tell horror stories of how they got addicted to opioids or how loved ones have died (usually taking a prescribed opioid in higher doses than prescribed and combined with other agents, which often is left out of the stories). Certainly we all share in their sorrow, but we cannot wear blinders to the patients that require therapy with opioids.
Has anybody offered expense or travel money to any patients that commented here?
PROP presentations notoriously start by saying there are no conflicts of interest to share from the pharmaceutical industry. That’s just wonderful, but who is spending this money (insurance companies, Workmen’s Comp?) to support this PROPaganda?
The stories we’re reading here from all over the country do need to be told, including those from medical providers that spend hours advocating for their patients (Dr. Murphy actually went under cover to observe?, Dr. Sachy and the investigator?) All of these stories are incredible and will not go unnoticed if I can help it.
Keep the stories coming please. Encourage medical colleagues, patients, and group members to post here and I promise to get these stories into the right hands.
WALGREENS IS WAY OUT OF LINE HERE. THE PHARMACISTS THAT WORK FOR THEM DO HAVE A PROFESSIONAL RESPONSIBILITY TO ACT ON BEHALF OF THE PATIENT. THEY ALSO HAVE A RESPONSIBILITY TO THEIR FAMILY AND THEIR JOB. THEY ARE BEING PUT IN A TOUGH SITUATION, AND BELIEVE ME, I KNOW FROM EXPERIENCE WHAT THEY ARE GOING THROUGH!
Keep up the fight, if not for yourself, for those that you love and love you!
Warmest regards to all,
Dr. Jeff Fudin
I live in Florida and I run a support group (online since 1996) for people who have, or have had, spinal fusions. Altho’ many of these surgeries are successful, when they go wrong, the results are usually devastating. I myself, have a broken screw and after 4 spinal surgeries, I still live a life of daily pain.
When I first fell off a step-ladder at work in 1985, I required emergency surgery (New Year’s Eve day) Pain management was basically non-existent, the laminectomy that was done didn’t relieve the pain and I starting drinking, self-medicating myself (booze is a great pain-reducer when taken with handfuls of Tylenol) I still, to this day, don’t know how I got thru’ those “dark times” all that pain.
I thought that those days were behind me. Here a few years ago, when pain was seen as the sixth vital sign and the nurse asked you to rate your pain, if you said you had pain. then there was the Patient’s Bill of Rights, another step in the right direction. Some say that doctor’s got to lenient with writing opiate scripts but I didn’t notice. I still had to be drug tested, keep contracts up to date and see only ONE doctor for prescriptions.
Now the pharmacies are taking their turn at playing doctor. First the DEA, shutting down legit pain doctors as casualties of war when they shut down pill-mills. I guess it’s collateral damage, or something. Pain patients are just like everybody else, but it seems our quality of life is always being held ransom by somebody trying to prove a point, or something. I sometimes feel like saying to the judgmental ones, “Hey, don’t you see that you are just a slip & fall or car accident away from being right where I am.” But what good would that do? So I write my Congress Reps and write posts like this and hope that things change before too long. My daughter is 36 and found out her pain is from Lupus. I need things to change for her. Thank all of you who are trying to advance this and keep it in the light.
Wishing all of you peace,
Katt Morris
Citrus County, FL
To Katt Morris, I thought you should have mentioned your group http://www.pediclescrews.com, for people who’ve had failed spinal surgeries with the screws implanted and to educate anyone who is considering this type of surgery.
We’re having the same problems with our pharmacies here in Maryland esp CVS! Walreens and a couple other major pharmacies. They refuse to take new customers or anyone who has legitimate scripts for strong pain meds. It’s awful to try 8 or more pharmacies and always get the same reply. “Sorry we can’t help you cause we’re not allowed to fill these medicines or we no longer carry any pain meds”.
We all have to stop this cause pretty soon all true chronic pain people won’t get any of their meds filled.
Thank you!
Thank you everyone for your responses, and especially my MSK friends for sharing your experiences, Dr. Sachy and Dr. Murphy. First of all, Dr. Sachy, I truly sympathize with what both you and your pharmacist friend have recently gone through. Although I can’t really say that I’m surprised by it. It’s like there is one huge covert operation going on involving the entire country, and nobody wants to take accountability for it. Funny how Agent X all of a sudden regained his memory towards the end of the call. Your friend was very generous to offer to start filling for your patients, and now because of that one man, more patients are going to be suffering needlessly because they can’t get their prescriptions filled.
This situation started out harming patients, but has gone above and beyond that to include both doctors and pharmacists, and with your post, you confirmed what I suggested in my email to Dr. Fudin; that pharmacists are in fact being threatened behind the scenes. If it’s going on there, it’s going on in all pharmacies – including Walgreens. The government officials that are supposed to be serving us and protecting us have turned into arrogant bullies, and are using strong arm tactics to do it. As I’ve said before, our government is getting way too big for its britches.
Dr. Murphy, my blood is indeed boiling, and has been for quite some time now. I saw an article a couple of months ago about the problems with Walgreens in Indiana as well, and posted it in my group as a warning to my patients there. While the majority of these issues were once basically confined to Florida (where I lived when all of this started happening), it is quickly spreading nationwide.
To give you a little background about me, back in the early-mid 90’s, I worked at Revco as a pharmacy tech. Licensing wasn’t required back then, and there were only 2 of our techs that were licensed. We were allowed to count opioids and get the bottles ready, but we weren’t allowed into the safe; we had to have a pharmacist get the medications out for us, and of course, they had to double check the pill count before we were allowed to bag them. We had 4 pharmacists at that store that worked in shifts, but our location was extremely busy, and we usually always had 3 pharmacists on duty at all times, and at least 3 techs, sometimes 5.
There were days when we had people lined up out the door to either pick up or drop off prescriptions, especially in the winter. We had 5 phones in the pharmacy, and at times, every available line was lit up and ringing while we were all on the phone. In a typical day, we filled anywhere from 300-900 prescriptions (yes, it can be done). A few times we filled over 1,000 in a day. If you’ve ever been behind a retail pharmacy counter, you know there isn’t a whole lot of room to maneuver. Needless to say, it was a very hectic, very cramped working environment. Despite that, I really enjoyed my job for the most part.
I saw people from every walk of life come into that store. From pregnant women, to people who had been in car accidents, people with infections or the flu, deaf/mute people that had a hard time communicating, even people who were there to pick up prescriptions for their animals. The look on a cancer patient’s face when you tell them their insurance will only cover part of their medication, and the balance that they have to pay is $20,000 is one of the most gut-wrenching things you’ll ever see – especially when they’re really too weak to walk and have to have someone physically hold them up because they’re too stubborn to stay in the car. I’ve had people cuss me out, I’ve had people break down and cry. I’ve gone through missing pill counts in the safe and trying to figure out where they went and how it happened. I’ve had to continuously keep an eye on customers that come into the store & watch where they go, because they look “questionable” when they come in and you’re worried about getting robbed.
You don’t really think about it when you are a customer, but it can be a very emotional and stressful job. I was there for almost 2 years, and during that time, CVS bought out Revco. I eventually left that store because my husband had a really bad car accident, and I had to stay home to take care of him while he healed. I eventually went to work at another CVS location and was there for about a year.
I guess the point I’m trying to make is that I can understand both sides of the coin here. I really can. If these pharmacists are indeed being threatened, and we’ve pretty much established that now, this is just adding to the stress.
As a patient, I’ve had to endure the hateful stares, the whispers about me between the tech that took my prescription and the pharmacist on duty, worrying about what I look like when I walk up to the pharmacy counter because I don’t feel well & am in sweats with no makeup on, I’ve been asked several times why I’m taking the medication I’m taking. My pharmacy has a copy of my pain management contract, and I spoke to the pharmacist on duty when I brought it in. I haven’t been asked for my medical records YET, but I’m assuming it will happen eventually, even though I feel it is a direct violation of HIPPA laws. Again, I’ve been behind the counter in a retail pharmacy and there is not a whole lot of wiggle room – storage of these medical records is a major concern for me and the MSK patients I currently serve as an Advocate. While I can see the importance of considering our pharmacists a part of our medical team, and in reality they really are whether some want to acknowledge that or not, others are very upset about this issue, and feel that it is none of the pharmacist’s business.
I currently have MSK patients in 40 states, along with patients in Canada, Ireland, the United Kingdom, Africa, Australia, New Zealand, The Netherlands, and Denmark. We are adding patients every single day from all over the world to our closed group on Facebook, which I am co-admin of. Right now, we have 709 members, with 13 of those being added in the last 3 days. While some of those are not MSK patients, they are family members or friends, the majority ARE patients. I just got another patient this morning that was asked by a pharmacy tech why she was taking the medications she’s on, and she’s really upset about that. This is almost a daily occurrence now in our group.
Switching gears, kidney stones have long been the butt of many jokes. While everyone knows that they are painful, for most people, they pass on their own and once they’re gone, that’s the end of it. MSK patients are NOT typical kidney stone patients, and we do not have that luxury, although we are always treated that way. Some of us will pass hundreds, maybe even thousands of stones in our lifetimes, while others of us, like me, can’t usually pass them and have to have repeated surgeries to get rid of them.
have patients that suffer from frequent infections that never, ever go away, no matter how many rounds of antibiotics are thrown at them (I am one of those…thank you biofilm infection), who urinate blood on a daily basis, who have hundreds of kidney stones in each kidney, as well as extensive Nephrocalcinosis (again, myself included), but are told that it’s no big deal, that it isn’t painful unless there is a stone obstructing – which is NOT true. I have patients that pass stones of various sizes daily, from 2mm all the way up to 8 or 9mm. Honestly, I don’t know how some of them do it – their ureters must be really large because of number of stones they pass, that’s the only thing I can figure. There are some patients that pass 8-10 stones a week or more. Some are constantly passing sand. Some struggle for weeks or even months while trying to pass stones. We’ve had at least 4 patients in the last 2 years that have developed Sepsis, two of which almost died. Many of us have declining kidney function, even though according to the medical text books, MSK doesn’t cause that because it’s a “benign” disease with no complications. Clearly, whoever wrote that has never had to live with this disease.
We have women who are currently pregnant, who have to deal with stones and infections at the same time, and who feel guilty and worried about the risks of taking pain medications. We have some who are completely bed ridden because their doctors refuse to give them pain medications, and who feel guilty about the time taken away from their kids and families. We have those whose marriages have been ruined because of MSK and our symptoms that go untreated for months or even years, and the strain is just too much. We have those who have been in so much pain that they’ve gone to the ER literally bent over, crying, and with their blood pressure sky high because of the pain, only to be told by the ER doctor on duty that they are an addict and he/she will not give them anything for pain. Some have contemplated suicide because the pain is just too much, and no matter where they turn, nobody will help them. Trust me, “benign” is the very last word I would ever use to describe MSK.
So, the lucky few (and it is very few) of us that DO get pain medications, after having to endure everything I just described on a daily basis, have to go the pharmacies, and get hassled there too. As if the fight with our doctors and our friends and families weren’t enough already. We have to endure yet another round of questioning, to explain our disease over and over and over again. And whether we can actually get the medications we need after that is totally up to the “pharmacist’s discretion.”
This is why I’m trying so hard to change things – maybe, MAYBE things would be a little bit easier if the medical textbooks and the information online reflected the true symptoms and complications of MSK. There are too many of us scattered all over the world for these symptoms to just be “in our heads” and for us to “just be trying to get pain medications.” Then I look at what’s going on around the country, and I sincerely worry about our future. I wonder that if I’m successful in getting the medical books changed, is it really going to matter in the long run if the government and those opposed to opioids get their way? And so the fight continues…
Mary Maston
MSK Advocate
Thank you for your enlightening feedback Ms. Maston!
I am glad this topic is being adressed. I was treated horribly at Walgreens and no longer go there. Something has to change.
Thank you Dr. Fudin for posing Ms. Maston’s email. And a big thank you to Dr. Sachy, Dr. Murphy, Dr. Ray and everyone else who has posted with compassion for us, the chronic pain patient. I’m yet another former Walgreens customer living in FL, my former Walgreens treated me in a similar manner as described by others in the posts, disregarding I was a regular customer with about 18 months of history of filling at said location, suddenly encountered a rude tech who gave me the “we don’t have this” without even bothering to give me eye contact, look up the info in the computer or treat me as a human being. That day I went to a few other Walgreens to no avail, one CVS, one private pharmacy, and ended up at Publix, and was treated totally different – the way you should be treated at a pharmacy with a valid prescription! I won’t even purchase so much as a newspaper from Walgreens, I know my business won’t matter to them, but hopefully as others have said, if enough people stop going there, they will feel the loss. Thank you Publix! To all the other pain patients, I am sorry for what we go through, hopefully one day the “pharmacy crawl” will be a thing of the past.
I am glad that the Walgreen problems is getting out in to the news now because I live in Florida and all pain patients here have been dealing with these same problems for over 2 years now. In fact, all pharmacies (not just Walgreens) in this state have been giving the same excuses as Walgreens to deny patients opioid pain medications. Imagine every pharmacy doing this in one state? This why I believe there is more to this situation. It’s probably the DEA scaring the pharmacists so they just refuse to fill these medications out of fear of losing their licenses? We do need to look at the DEA. It would help if the government would look into the DEA and find out why they are causing legitimate patients to suffer so badly, after all the DEA stated they had no intentions of harming legitimate pain patients but they are and without any remorse. Now the problems are spreading to all other states.
I hope with the all publicity happening with Walgreens that it will inspire the pharmacy boards to call a meeting to discuss this and find a solution very soon. Pain patients are suffering in very large numbers with no relief in sight for Floridians. I know this is a wide spread problem because I have been getting calls from pain patients from many other states all saying the same things. I just pray that something soon gets resolved because this is cruel and needs to stop. Thank you Dr Fudin, Mary Maston and everyone else for bringing this story out into the light.
8/10/13
Yes, this has indeed happened at various Walgreens, CVS s, etc. in Georgia, and perhaps here is a possible or partial explanation as to why; and it involves the absolute unethical behavior Georgia Law Enforcement Agencies and their “police” arm – The Georgia Drugs and Narcotics Agency – http://gdna.georgia.gov/.
In the early spring of 2013, I [a Neuropsychiatrist who also practices pain management] had a session with the mother of a child patient. The mother is also a pharmacist, but who does not work at Walgreens. In the past I had mentioned to the child’s mother, the trials and tribulations of my pain patients in their attempts to obtain their opioid analgesics [I WILL NEVER USE THE PEJORATIVE TERM – NARCOTICS] for their chronic pain conditions. And so we discussed the pain and suffering of those forced to endure the “Pharmacy Crawl”. This pharmacist informed me that no Federal DEA agent had recently bullied her about pain medications or their supply and that the pharmacy that she worked for had adequate supplies of all of the opioid analgesics including the “dreaded” Oxycodone. So, she told me to send any pain patients of mine to her if they were having trouble obtaining their medications because she had seen my practice and she trusted me.
Well, I saw her and her child again approximately 1.5 weeks ago for a follow up appointment. She said she had something important to tell me. She stated that on July 3, 2013 [apparently a busy day for pharmacists], she received a visit from our local Georgia Drugs and Narcotics agent, who I will refer to as Agent X. Agent X is a short, balding pharmacist who carries a large semi-automatic gun, holstered in plain view of my patients whenever he has come to visit my practice. Thus he is easily identified.
The child patient’s mother told me this: On July 3, 2013 Agent X came in to her pharmacy and “pulled” one of my larger prescriptions for oxycodone [for a middle aged man with failed back syndrome, who walks bent over at a 30 degree angle, and who cannot sit down for his appointments with me because of…….PAIN. AGENT X THEN TELLS HER PLAINLY AND REPEATEDLY THAT NO “REASONABLE PHARMACIST” WOULD HAVE EVER FILLED THIS PRESCRIPTION OF DR. SACHY’S. He goes on to tell her that he is an “Expert Witness” and that he could never defend her in court if this particular patient overdosed. And when she defended me, the patient and the prescription itself for being “appropriate”, AGENT X TOLD HER THAT THE PATIENT MUST BE SELLING SOME OR ALL OF HIS PRESCRIPTION!
Well, I was flabbergasted, insulted. I felt slandered… in an intimidated way. The pharmacists begged me to say nothing to Agent X as she was obviously intimidated by his actions and statements. So I stewed upon this incident over the weekend. Then on the morning of Monday August 5, 2013, I made my decision.
1. I had my staff call that patient whose prescription was under scrutiny. He was told he had till noon [2.5 hours from the call] to be at my practice with all of his bottles and medications.
2. He showed up – upset after I told him and his wife who accompanied him what had transpired recently regarding a prescription of his from several months ago. His wife began to sob…I had put them through interrogations before when I have suspected anything. And they are used to being treated like “scum” by pharmacists etc. because of the husband’s prescriptions. I explained how sorry I was but that this was part of being a legitimate pain physician.
The patient was in the middle of his prescription time period and by my pill count he was 2 days short of his oxycodone. I was angry. I read them the riot act again about compliance, and they then both broke into tears explaining that with his level of low back pain and radiculopathy, he sometimes he has to take one or two extra tablets to endure the pain. Yes they could have been lying and I understand that. But I am a pain physician and if this man and wife are diverting oxycodone, it should be easy and ethical for law enforcement to discover this and inform me of it – you would think…
And if the Georgia Drugs and Narcotics Agency knew for certain that this patient and/or his wife were diverting oxycodone, then it would have been be absolutely and criminally unethical if they did not inform me about it so that I could take appropriate action. And if this patient had been doing nothing wrong, then Agent X was/is guilty of:
A. Practicing medicine without a license.
B. Slandering me, the patient, AND THE PHARMACIST.
C. Guilty of other civil rights violations and professional conduct infractions too numerous to count.
3. I then had the patient and his wife sit down in my office and be silent. I told them that I was calling Agent X on speakerphone to get his explanation of events. I documented the call electronically. I luckily got through to Agent X. I told him of what I had been made aware of without mentioning any pharmacist’s name. I told him that the patient in question and his wife were sitting before me. I told him that they and I would like to have a meeting at a time of his convenience to discuss and defuse this situation.
Here is what AGENT X said in a nutshell:
He stated that I was not under investigation by him. He had no knowledge of any such event. He even was not familiar the pharmacy in question [he did ask which one it was]. He stated that he would never say such things to a pharmacist or anyone, and that from his past interactions with me he had no problems with my prescriptions.
He then stated that someone must have come into the pharmacy in question and impersonated him. [A short, bald man with a gun and GDNA badge]. He said that it was probably a Federal DEA agent posing as him…as part of some undercover operation [apparently according to Agent X, he has been impersonated before by other DEA and/or Law Enforcement Agents during past undercover operations].
Interestingly, Agent X did not respond to my offer to meet with him and the patient to set the record straight regarding the patients’ medical condition and his need for large doses of pain medications.
However, I and the patient were most appreciative when Agent X stated on the phone that the patient’s being approximately 2 days short of his oxycodone was “not inappropriate”.
SUDDENLY DURING THE TAIL END OF THE CALL, AGENT X STATED THAT HE NOW REMEMBERED BEING IN THAT PHARMACY ON JULY 3, 2013, WHEN HE FIRST ADAMANTLY DENIED THAT HE HAD BEEN THERE AND THAT HE HAD NO OR ONLY BARE KNOWLEDGE OF THAT PARTICULAR PHARMACY.
Well I thanked Agent X for the opportunity to “clear the air”. I gently reminded him that if law enforcement knows that a patient of mine is diverting their medications that it would be unethical of them not to inform ME of this fact/suspicion so that I could take the appropriate steps to dismiss the patient if need be.
So, this part of the day ended with the patient walking out, head hung low, angry and humiliated. His wife followed, sobbing quietly.
AND NOT 5 MINUTES AFTER THIS, THE PHARMACIST IN QUESTION CALLED ME TO INFORM ME THAT AN ANGRY AGENT X HAD JUST CALLED HER DIRECTLY AND IN ESSENCE “GIVEN HER HELL” FOR GIVING ME THE INFORMATION THAT SHE HAD PROVIDED. But she understood why I had to call him and she was not too angry [I hope], and the why of it is this…
All of us pain practitioners and pain patients must stand up to unreasoning prejudice, hypocrisy, and unethical/corrupt behavior regarding pain medications, wherever and whenever we can.
That pharmacist in this case is a HERO for doing what she did…
She is also a human being…
She ended the call to me by asking me not to refer her any more “new” pain patients…She did not want any more trouble from Agent X and his masters.
And so, is there a partial explanation for pharmacy “shirking”?
Yes. It is due to unethical McCarthyite intimidation by those who are afraid to admit to their statements or their identities – or those who fail to show up at public debates regarding pain medications, for fear of being exposed as – unreasoning, unethical thugs.
Thomas Sachy MD MSc.
Neuropsychiatry, Forensic Psychiatry, Pain Management
Diplomate of the American Board of Psychiatry and Neurology
gapbm@hotmail.com
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UNDERCOVER PAIN DOC
I am a Pain Management specialist is Jeffersonville, IN. Walgreens has told my staff, my patients, and me that they need to provide the pharmacy a copy of the most recent office note or else prescriptions from our office will not be filled. Mind you, I am board-certified in Pain, Anesthesiology, and Addiction. I am on faculty at the University of Louisville and fellowship-trained at the Mayo Clinic. I am also the President of the Greater Louisville Medical Society. Yet, a prescription from my office poses too high a risk?
Another colleague in Southern Indiana, a psychiatrist with training in pain management, has been informed by Walgreens that they will fill none of her prescriptions because they have determined that pain management is beyond the scope of her practice.
Is your blood boiling yet?
Two weeks ago I went “undercover” with a patient to Walgreens to see if they would fill his wife’s prescription for Percocet. He looks like a kindly grandfather and I looked like a typical middle-aged guy with a ball cap. Walgreens filled that prescription with no questions asked. It might as well have been penicillin. Very routine.
So it this a softening in the policy? Or was this an oversight on the part of the pharmacist? Or are they really applying these policies haphazardly and / or randomly?
I guess this issue is still evolving. The efforts and the pressure applied by good people like PROMPT and the bloggers on this site is essential to the cause. Keep up the fight! And many thanks to Dr. Fudin for his generous advocacy.
James Patrick Murphy, MD, MMM
TWITTER @jamespmurphymd
The DEA fined Walgreens 80 million dollars over some issues about prescribing pain meds.. and basically told Walgreens that they had to be more careful in who they fill pain medications for.
It seems people who transfer their medications to other pharmacies this would hurt the bottom line for Walgreens.
This huge chain really needs to come up with some kind of answers available for customers needing pain meds filled. Its hard enough finding a Pain Specialist willing to
prescribe to those that suffer from chronic pain. Then when we finally do find a compassionate doctor and go to the pharmacy like Walgreens they refuse to fill these scripts.
Something is really wrong here, where is the compassion they once had. The thing is these pharmacist are rude and they don’t care if you’re a chronic pain sufferer.
Here are some interesting links for people to read about Walgreens.
link: http://www.wthr.com/story/22916123/2013/07/23/walgreens-pharmacists-now-turning-away-some-customers-who-need-pain-meds
link: http://www.nytimes.com/2013/06/12/business/walgreen-to-pay-80-million-settlement-over-painkiller-sales.html?_r=0
link: http://www.pharmaciststeve.com/?p=4058
Unfortunately I live in Florida and suffer from a very rare Kidney Disease called Medullary Sponge Kidney(Bilateral) w/ Kidney Stones as well.. I live in constant pain and my kidneys are so impacted with stones that there’s nothing that can be done other than to let me keep passing them hoping that I don’t end up w/ one getting stuck and requiring surgery for removal and keeping me somewhat pain free.. I’m never pain free because if something happens I need to feel it.. Anyhow I have had some Major dealings w/ Walgreens down here.. Just a week ago I went 3 days w/ out my break through pain meds cause of no one willing to fill the script. I get my scripts filled every 2 weeks cause of no health insurance and it’s very exspensive and the only way I can afford it.. I pulled up to a Walgreens and the Tech opens the drawer, I placed the script in (mind you I was in to much pain to get out of my car and walk in) and it took awhile then she came back and told me it was to soon.. Mind you I had at that point been 3 days w/out my medication and I informed her that no it wasn’t, It was a 2 week script so she walked away again.. I could see her and the pharmacist looking something up on the computer.. It was my history of where/ when I get my prescriptions filled.. Then she came back and refused to fill it because they didn’t like how mant hrs I am to take it.. Pushed the drawer back open and told me to go to Publix which is where I normally get it filled but for some reason they didn’t have it in stock, so I drove around for 3 days trying to find someone who would fill it. At the end of the day I couldn’t drive so my hubby drove me around after continuing to get turned down I came accross a pharmacy that would fill it.. My husband was about to take me to the hospital because he was scared of what might happen to me as he had told me that I was pale white and wasn’t feeling well.. I also suffer from a heart disease in which my heart beats to fast and I have Gran Mal Siezures too.. Not just pain and a Kidney Disease.. It’s sad that every 2 weeks I go through this.. And it only seems to be getting worse down here in Florida. What I would like to know is how those that don’t need the medication are getting their hands on it but those of us who need our medications just to live somewhat of a “normal” life are having such a hard time.. When it comes to getting my scripts filled I absolutely dread it!!
It SHOULDN’T be this way!! Something needs to change!! I think I’m going to start carrying around some of my medical records.. Maybe I WON’T have to wait or better yet end up in the hospital. Due to lack of Medication as well as the other health issues I have that I also have been told that they are stress and pain induced…
Chrystal D. Hassel
My wife works in a Pharmacy in a small town in missouri as a tech, right across the street is a walgreens. last year i was told that the walgreens pharmacists called the manager of the pharmacy that my wife works for to discuss some changes to walgreens that has undergone that will affect the pharmacy that my wife works for…My wife asked her boss what walgreens was up to, and was told she could not discuss it with her… I Have adhesive arachnoiditis, and have filled my pain meds at my wifes store for awhile, without any problems… soon after this phone call took place, i had to wait for a few days to fill my meds because of an unexpected increase of new customers at my wifes store creating a shortage.. i took my pharmacy a few months to adjust their ordering practices to account for all the walgreens pain customers… it is pretty obvious that it is a walgreens corporate policy to deny most scripts presented. By talking to my wife, the ones that became newer customers to her store were younger in age.. so apparently this new policy has some guidelines for the pharmacists to follow, cutting out the ones they deem a higher risk based on age…. if walgreens says they leave it up to the individual pharmacists they are full of bologna!
Dr. Fudin,
Thank you for posting Ms. Maston’s recent letter and the subsequent posts by Mr. Neeland and Mr. Barletta about their negative experiences in trying to have opioid prescriptions filled at Wallgreens. I fear that we are in a situation that is about to spiral dangerously out of control in community pharmacies across the nation! I have been a pharmacist for 32 years and I’m seriously concerned that our profession has lost its moral compass. In so many situations we see healthcare professionals, especially community pharmacists apathetic to plight of the larger majority of patients with chronic pain problems due to the growing numbers of people who misuse/abuse and/or addicted to prescription opioids and the rising tide of prescription overdose deaths.
Who created that situation – the physicians, who maybe well intentioned but poorly trained in pain management and addiction that prescribed them to wrong patients with conditions that would not respond well to opioids and at risk of misuse. And the pharmacists (equally poorly tranined in pain managment and addiction) who blindly filled those prescritpions without any thought as to the consquences of their lack of attention to detail – “I just filled the prescription as written by the doctor”.
Now we have the situation where we have pharmacists refusing to fill prescriptions because of corporate constraints and conerns (and pharmacists fearing for their jobs). They have not received additional training to make sure that the patients that have a legitimate need for precritpion opioids receive them and others do not (but also receive help for their illness of addiction). The same pharmacist who would have had the defense that “I just filled the prescritpion as written by the doctor” will be the same who are outraged by the AMA resolution that basically just says “shut up and fill the prescription – you don’t have any right to call me and discuss my patients care with me – you are just the pharmacist”.
Physicians and pharmacists share equaly the responsiblity of not fulfilling our professional oaths to our patients. Resolutions by the AMA and lack of response by professional pharmacy organizations will not solve the problem of patients dying of prescription opioid overdoses or the millions of patients with chronic pain that need these drug to function who will suffer from now not receiving them. The DEA providing “opaque” guidance to corporate pharmacy businesses about how they should address these issues has only made the process more complex and polarized.
What is needed is for all the stakeholders (more than I can count on my fingers and toes) to get into a room and not come out until there is some consensus about how to move forward. I have personally, or through contacts, reaching out to the American Society of Heatlh-System Pharmacists, the American Association of Colleges of Pharmcy and the National Association of Chain Drug Stores to ask folks to get engaged with the AMA, DEA, patient advocacy groups and others – not to be silent. We as pharmacist all have a personal responsiblity to act to protect our patients welfare & health – this isn’t someone else’s responsiblity – it is our professions responbility which means everyone one of us. If we sit and remain silent then we are complicit in the harm we do to our patients and the social injustice that is a result.
Thank you for continuing to make these issues public, I hope that our profession can find its true North again soon.
Dr. Ray,
Thank you for your thought-provoking comments that elucidate a shared moral and ethical obligation among all the professionals involved. More importantly are the responsibilities we all have now to fix these broken issues in an effort to do what is right morally and ethically for the betterment of patient care. It is a horrible situation when patients who reply on medical doctors and pharmacists have to second guess our ethical standards which ultimately affects their personal fate.
Thank you for initiating contact with so many groups already to make things right. True north is certainly where I hope we eventually aim our compasses.
Thank you James! finally another passionate voice for the victims of this harm. Your kind are few and far between..
Everyone is allowed a opinion but I feel a pharmacist has no right to refuse a valid medical professional doctor Rx as each pain patient is not treated equally It also angers me to hear accusations that it is a doctors fault for the drug addicts in our society. and the overuse of pain medications.I feel that a professional will be able to assess the patient and do whatever diagnostics needed to ensure the patient is in need of pain meds as well as to protect his medical license
There are illegal drugs coming from Mexico and elsewhere
Cathya,
Your statement “a pharmacist has no right to refuse a valid medical professional doctor Rx” could not be further from the truth. Pharmacists have every right to do this and are legally and ethically obligated to do so. Pharmacists are experts in medication therapy and spend many years in college mastering topics such as pharmacology, pharmacokinetics, medicinal chemistry, pharmaceutics, and much more.
I stopped using Walgreeens a few years ago when the pharmacist not only called the prescribing physician to have my pain medication script changed to a lesser amount, but told me she thought I was an addict. I switched to CVS and have never looked back. I am always treated with dignity at my local CVS store. I only wish I’d made the change sooner.
It hurts my heart to think of other patients being treated the way I was treated and left in the lurch by ignorant pharmacists.
I suffer from MSK (Medullary Sponge Kidney is birth defect that became symtomatic in my 30’s) . FOR YEARS I have been under doctors care and all’s the doctor can do is help me manage my pain and I am on a very strict diet to stop the constant formation kidney stones. There is nothing more they can do for.me but life must go on. I have decent care but I have become a member of a support group that has 700+ members. There are so many people that have to travel an obnoxious distance to TRY and get medication. Sometime the prescription is filled and other time they are forced to keep on traveling until someone is willing to fill the prescription written from a legitimate doctor for legitimate pain. It sickens me to see how we are being force to be at the mercy of the pharmacy. THIS MUST CHANGE. Imagine trying to pass kidney stones regularly and having to be at the mercy of a DRUG ESTABLISHMENT to provide the service they are in business for..I live in constant fear that someday I will be forced to pharmacy shop. I’m so appalled that people have to add more stress to an already horrific disease. Thank you!
Dr. Jeff, thank God I don’t have to deal with Walgreen’s anymore. I am a W/C patient, and I now receive my medications from a warehouse. The Walgreen’s thing, once a month was so traumatic that it caused me to be so anxious when I walked in, that my attitude was simply defensive when I walked to the window. The Pharmacists would be different, every time. They would be shifted to the five or six stores in the area. After time you knew the one’s that were going to give you nothing but fits. Its’ a damn shame that when a person who is in such pain had to put up with a PROFESSIONAL with a horrible attitude. I mean horrible. Like we OWE them something.
It got to the point that I would point to the top of the prescription and say, “Please call the office before you give me any grief.” Some would say, “What grief sir?” Or, some would just call the number, all the time looking at me like I was a thief.
I think there is a lot of inservices they could provide to the “TECHS”. I don’t know what kind of training they receive but most of the time you can tell, it’s not in customer service. Are they told that anyone that has a controlled med. just say, “NO?” Just one example. I walked up to a counter at a Walgreen’s a few year’s ago, and the tech greeted me with a “NO”. That was it. She said, “I know what you want, and we don’t have it.” Well, that did not end well for her. I wrote her up. I presented it to the pharmacist, as requested, and didn’t see her again. BUT, how many others’ have been greeted that same way? I know, there are a lot of folks out there trying to get medications illegally. BUT, the one’s like me. The Arachnoiditis patients that constantly fight, every month, there has got to be some relief. I am a moderator in the group, COFWA. I see this nearly everyday. Someone has had to go to a Walgreen’s. What a horrible spot to be in. And, it should be against the law to treat an honest person this way. OH well, this will con’t. I am afraid………………………Thanks Dr Jeff,,,,,,,,,,,,,,,Herb “doc ” Neeland
I used Walgreens to fill all my medications THEN one day not that long ago they refused to fill the long acting pain medication I’ve used for many years and they refused to fill the break through pain medication. I asked why cant they fill it and they said the reason is the count was to much . They where telling me it was too many pills to fill for a months supply. Even though when this particular medication came in 40 mgs diskettes it was never a problem for the same amount of medication, just less pills that makes no since. So I refuse to use Walgreens, they will fill topical creams for dermatology, but when it comes to opiates they give the script back to me and refuse to fill it, so I take my business elsewhere. It seems Walgreen pharmacist have the different type attitude than say a pharmacist from a Good Neighbor pharmacy.
I don’t care what the reason may be, but it seems a large chain like Walgreens would fill these medications. Or maybe if I where 20 years older it would be a different story I don’t know, but I do know I will never use Walgreen’s again.
Mark S Barletta