Are Pharmacies Blackballing Physicians Writing Opioids? 

A colleague, Dr. Bill Jones (not his real name), recently wrote me about a serious threat to his career.

One of Dr. Jones’s patients, who is on chronic opioid therapy, told him that the Drug Enforcement Administration (DEA) had blackballed him. The patient tried to get a prescription for her usual meds filled at a pharmacy at her local supermarket, but they told her they could only fill a one month’s supply of the medications. According to the patient, Dr. Jones was on a list of the top five  prescribers of opioids in the area, and the local pharmacies were all being intimidated into not filling his prescriptions. Admittedly, it is unclear what “intimidated” means.

Dr. Jones said he tried calling the supermarket’s district pharmacy manager, but they didn’t call back. Therefore, he has not been able to confirm what his patient told him. The patient told Dr. Jones that she had phoned many pharmacies, but they all told her the same thing.

Maybe so, but I suspect there is more to the story.

Is the DEA Pressuring Pharmacies? 

Obviously, there is a concern if the DEA, or any law enforcement, is pressuring retail pharmacies into not filling opioid prescriptions from any opioid prescriber.

Unfortunately, Dr. Jones is not the only physician who has been told that his prescriptions would not be filled. Via a separate email message from another doctor, I learned that a pharmacist claimed to have received a letter from the DEA stating that 60 mg per day of oxycodone was too high and the doctor needed to explain why the patient needed that dose. The doctor asked to see a copy of the letter that the DEA allegedly sent, but the pharmacist declined to provide it due to HIPAA.

So the DEA’s involvement in these situations is uncertain, and entirely speculative. There may be pressure on pharmacists to not fill prescriptions from some providers, but it wouldn’t necessarily mean that it is the DEA putting pressure on the pharmacies. In fact, the DEA doesn’t have any legal authority to direct a pharmacy to not fill any provider’s prescription.

Law enforcement officials might suggest that pharmacists be certain that prescriptions written have a legitimate medical purpose. In fact, the law stipulates that a pharmacist has a responsibility to ensure prescriptions are for a legitimate purpose.

Separately, law enforcement has (or can gain) access to the state’s prescription monitoring program in many states. If that happens, then these individuals can use the information in inappropriate ways.

However, if a state agent (often mistakenly referred to by practitioners as a “DEA” agent) were to have access to Prescription Drug Monitoring Program (PDMP) data and then misuse it to direct a pharmacy to not fill prescriptions from a given provider, that would likely constitute an unauthorized disclosure and a potential felony violation of the state’s PDMP statute.

David Brushwood RPh JD several years ago wrote about a police officer in TN who believed that his superior officer was acting strangely and might have been misusing controlled substances. The officer convinced a pharmacist who was a friend to run the superior officer’s name in the state PDMP. The curious officer later was brought up on charges and fired. His firing was upheld by the state’s court of appeals. The pharmacist (who tapped into the state PDMP at the request of the officer) was not charged or held criminally responsible for complying with what he believed was a lawful request from a police officer.

This situation suggests that there is potential for improper use of confidential medical information, but how frequently this occurs is unknown.

Patients Are Being Denied Access to Their Opioid Medication 

So, what does this mean for Dr. Jones’s situation? Regardless of the reason, Dr. Jones’s patients are being denied access to their medication, it has significant implications:

• First, Dr. Jones is being targeted because of his prescribing without due process, which could force him out of practice.
• More importantly, Dr. Jones’s patients may find it impossible to find a provider willing to treat them. They may be forced into withdrawal or to seek other, riskier ways to treat their pain.

We can see how this might play out via another email I recently received from a person in chronic pain seeking advice “on recent changes to insurance company policies in Washington State.” This patient stated that her doctor feels compelled to limit her dose of medication to 120 mg morphine equivalence. In this case, it isn’t a pharmacist who refuses to fill a prescription, but it has the same effect on the patient.

This patient said, “Doctors are being threatened by insurers and patients are left with severely under treated pain. What do we as ‘legitimate’ pain patients do? I’ve already lost one friend to suicide from chronic pain, and another is currently contemplating seeking pain relief on the street. I understand the opioid addiction issue needs to be addressed, but where do we turn to fight for our right to have safe, appropriate pain control so we have some semblance of a quality of life?”

Blackballing Is Not Clear, But…

It is not clear that providers are actually being blackballed, per se, but, if pharmacists won’t honor their prescriptions even some of the time, then their ability to effectively treat their patients could be compromised. Absent proof of what’s actually happening, I would conclude that some providers may be targets by state or federal agencies, or payers, as part of the effort to reduce opioid prescribing. Dr. Jones may be one of those targets. The consequence may be that people in pain will be severely underserved. That would be very unfortunate.

If this happens to you or to anyone you know, I urge you to contact your U.S. senators and congressman to ask for help. Ask that they help protect your right to be treated as your physician recommends. Ask that they prevent interference from law enforcement and payers in the patient/physician relationship. Ask that people with pain be treated with dignity and respect. This should be everyone’s inalienable right.

Do You Need Help? More Info: 

To find your Senator or congressman and their contact information, go to http://www.lynnwebstermd.com/send-a-letter-to-congress/.

 

Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD