The cure shouldn’t kill

Abstract

when it comes to analgesia—the main focus of our special pain section in this issue of Pharmacy Today—CDC statistics paint a grim picture: 100 people die from overdoses of drugs of all types every day in this country, 14,800 Americans died from overdoses of opioids in 2008, and overdose deaths have more than tripled since 1990. Those figures are just the tip of a very big iceberg. For every person who dies, 10 others are admitted for treatment of opioid abuse, 32 visit emergency departments, 130 are abusing drugs or are dependent on them, and 825 use such drugs nonmedically (without a prescription or for the “high”). DEA, an agency that has always struggled to balance its cops-and-robbers side with regulation of learned professions, has responded by cutting off the supply of drugs to some pharmacies and fining others. Unfortunately, supply-side pressure on wholesalers, pharmacies, and prescribers is impeding the proper care of real patients with real pain. Chris Herndon, the guest editor of our pain section, recounts the Walgreens experience in his editorial on page 49. The company’s current practice of contacting prescribers to confirm the medical necessity of prescriptions for controlled substances led to resolutions in the American Medical Association (AMA) House of Delegates about the deluge of pharmacy calls and faxes. CVS Caremark took a different approach. As reported in the New England Journal of Medicine, 42 prescribers were identified out of more than 1 million based on questionable prescribing patterns and patient factors (paying cash for prescriptions and younger ages). About half of those did not respond to queries or had insufficient justification for their prescribing patterns; they have been placed on a companywide do-not-dispense list. What is the solution to this toxic mixture of clinical, policy, and personal responsibility problems? I’m sure I don’t know, nor does any other one person, group, or organization. This is a national problem—a crisis, in fact, I would argue—that calls for action. We have reversed such tragedies before; the right mix of public education and law enforcement dramatically cut the number of people killed in alcohol-related traffic accidents over the past 3 or 4 decades. APhA is actively looking for ways to lead on this issue. One solution to AMA’s concern with phone calls from pharmacists is providing pharmacists two-way access to electronic health records—a goal of APhA and the Pharmacy e-Health Information Technology Collaborative. We are looking for ways to work collaboratively with DEA, wholesalers, medicine, and other stakeholders to find sensible solutions. Without action, the number of people affected by this medication-use problem will climb, related problems will grow, disabilities that are really addictions will continue, and patients with legitimate needs for pain medications will needlessly suffer. Your ideas or experiences on this issue are welcome. Join our discussion of this topic at apha. us/PTLinkedIn after you’ve enjoyed your September Today!