For a few years now, government regulatory and law-enforcement agencies have been fighting a war against prescription painkiller abuse. With abuse, theft and overdose on the rise, that's exactly what they should be doing.
However, the battle lines have been blurred, with those agencies sometimes coming between doctors and legitimate pain patients. It's caused all of us on prescription narcotics to be viewed with suspicion, and it's cost far too many people the medications that help them function.
Now, the Drug Enforcement Agency (DEA) is trying to put pharmacists in between doctors and patients. Calling them the "last line of defense" against prescription fraud, it's asking pharmacists to contact doctors not just to verify prescriptions for controlled substances, but to ask about:
- the rationale behind the prescription,
- the diagnosis,
- the treatment plan,
- the ICD-9 codes for the diagnosis,
- and previous treatments that have been unsuccessful.
Seriously? I understand that pharmacists are doctors, and they are the experts on drugs. Still, they aren't clinicians or diagnosticians. Should someone who's never had a conversation with the patient, and who doesn't have access to the chart and medical history, really be making decisions about treatment? Over-ruling doctors' decisions?
It's hard enough to find a doctor who will treat illnesses like fibromyalgia and chronic fatigue syndrome. So under this plan, we'd have to find the right doctor for us, arrive at a treatment plan, and enter into all of the doctor's required painkiller contracts, only to have the pharmacist say, "No, I don't approve"?
Fortunately, this time we have an ally. The American Medical Association (AMA) has issued a warning against what it calls "inappropriate inquiries" from pharmacies that try to dig into these aspects of treatment, saying it's "unwarranted interference."
Okay, so doctors are standing up for themselves, and, by extension, us. They should. However, what does that mean for pharmacies?
With the DEA looming over them and the doctors refusing to play along, will pharmacies keep doing what they've always done, or will they - out of fear - decide not to honor prescriptions if the doctors won't answer their questions? If so, where does that leave us?
Just as many of us have gone untreated because of doctors' fear of the DEA, I'm afraid that more will go untreated because pharmacies fear the DEA. Some people will suffer, and some will probably turn to illegal online pharmacies - which means they're becoming part of the problem the DEA is trying to solve.
Being Treated "Like a Criminal"
Meanwhile, we pain patients will just have to get used to certain things. I hear people say all the time that they're being treated like a criminal when their doctor requires things like painkiller contracts, urine testing, etc.
This week, the AMA held free webinars for doctors to teach them about incorporating urine drug-testing into their practice and how that works with their chronic pain patients, as well as how to treat chronic pain while watching for substance abuse, and the appropriate role of opiates.
"Prescription drug abuse is a serious epidemic that cannot be ignored," said AMA President Jeremy Lazarus, MD, in a press release. "Any action we take to curb it must ensure that patients who are suffering from chronic pain get the treatment they need."
I appreciate how difficult it is for doctors to deal with potentially addictive painkillers in chronic pain patients. I understand that they're trying to protect both us (from addiction) and themselves (from legal action.) With more people dying from prescription painkiller overdose every year, they have to do something.
I just hope they can find a good balance, because I, for one, function a lot better when I can take an occasional Vicodin to manage my pain. I've had to fight to keep that prescription, even though I'm on the lowest possible dosage and only get 20 pills a month. I don't need painkillers every day, but when I need 'em, I need 'em.
So while I don't like medication contracts and close doctor scrutiny, I'll accept it. I'll cooperate with urine tests if I need to, and I'll sign my life away at the pharmacy after waiting a little extra time for them to call my doctor's office and make sure the prescription is valid. I want the prescription drug abuse problem to be battled, and I want the battle to succeed. If I have to be inconvenienced and jump through some hoops that make me feel like a suspect, I'll do it. Why? Because it might keep legitimate pain patients like you and me from becoming collateral damage.
Have you had to fight to get proper pain treatment? Does your doctor refuse to prescribe opiates/narcotics? What do you think is reasonable in the drug-abuse battle, and what do you think is going to far? Leave your comments below!
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