More Headaches for Pain Patients

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Two articles—one in the Wall Street Journal, the other in the Washington Post—suggest that while the situation is easing for those whose pain is relieved by marijuana, those who require stronger, prescription painkillers are facing more obstacles to relief.

The Post covers a call by two Democratic Senators for the Drug Enforcement Administration (DEA) to change its rules regarding the use of opioid pain medications in long-term care facilities and nursing homes for the elderly. The Journal explores litigation that could affect the availability of these medications at pharmacies.

The nursing home regulations—which are supposed to prevent diversion of medication to drug addicts—instead seem to be making the elderly suffer by requiring a doctor’s signature for certain medications to be ordered.  Of course, doctors aren’t always around to sign paperwork—so patients have to wait, often in severe pain.

In their letter, Senators Herb Kohl (D-WI) and Sheldon Whitehouse (D-RI) write that the regulation “fails to recognize how prescribing practitioners and the nurses who work for long-term care facilities and hospice programs actually order prescription medications.”  They say that delaying pain medication can produce “adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering.”

The Journal examines possible lawsuits against pharmacies which fail to determine that their patients are misusing drugs and stop their prescriptions.  Pharmacies can be warned by law enforcement about suspicious patients—but these warnings can also result in needed medication being denied.

In the case covered by the Journal, the families of one man who was injured and another who was killed by a woman driving under the influence of painkillers are suing the pharmacies that sold the medication and failed to respond to law enforcement warning that she had been identified as a possible addict.  Pharmacies are caught between a rock and a hard place here:  if they deny necessary medications they can harm patients and may be sued for that– but if they don’t catch drug addicts, they also face legal action.

Writes the Journal:

Some predict higher insurance costs and more expensive prescriptions, to absorb the costs of additional lawsuits. In court filings, Wal-Mart argued that pharmacies might decide not to stock certain regulated painkillers. Walgreen suggested that the judgment of pharmacists could be pitted against that of doctors, as pharmacists struggle to decide whether to refuse a prescription.

Michael Wall and L. Kristopher Rath, attorneys for Longs Drug, now owned by CVS Caremark, predicted a “tsunami of litigation” if the families prevail. Drugstores could be sued by their own customers if pharmacists refuse to fill valid prescriptions and customers are harmed, they said. Drugstores could also be sued by those who claim to be injured by a customer who purchased prescription drugs.

Meanwhile, there is little evidence that these supply-side measures to fight addiction have any influence on the ability of addicts—as opposed to legitimate patients—to obtain drugs.