Access to painkillers disrupted by unpredictable supply chain

Patients who need painkillers have had to wait more than a week to fill their prescriptions at local community pharmacies or, in some cases, have had to go to other pharmacies, according to a survey of more than 1,000 pharmacists conducted by the National Community Pharmacists Association (NCPA).

“Vulnerable patients are increasingly and tragically becoming collateral damage in the country’s battle against the abuse of prescription drugs, particularly narcotic painkillers,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “In the survey, community pharmacists repeatedly cited having their supplies or shipments of controlled substances abruptly shut off by their wholesalers, which may have done so due to perceived pressure, intimidation, or lack of clear guidance from law enforcement officials such as the [U.S] Drug Enforcement Administration (DEA).”

Responses

Of the pharmacists who responded to the survey, 75% said that they had experienced at least three delays or problems with controlled substance shipments over the last 18 months. The delays in shipments for the medications lasted at least one week, according to 60% of those surveyed. In addition, the delays affected, on average, about 55 patients per pharmacy.

Often pharmacies had not been contacted in advance about the stopped shipments of controlled substances. Delays were only evident when the orders were opened and contained no controlled substances, the NCPA survey revealed.

More than two-thirds of the pharmacist respondents were not able to obtain controlled substances from other sources, such as a secondary wholesaler, NCPA reported.

One pharmacist wrote on the survey “we try to scrutinize all controlled substance prescriptions, but are made to feel like criminals when trying to service our patients.”

Another stated, “This situation has literally brought customers to tears in our store. I fully understand the diversion and abuse of these powerful chemicals. I agree that something must be done, but to deny pain management to deserving individuals is inhumane at best. We have to find a way to curb the abuse and still provide relief from pain for those truly suffering.”

Recommendations

NCPA recommendations to combat prescription drug abuse include:

*Electronic prescription drug monitoring programs and tracking systems

*More effective education of prescribers

*Closure of rogue pain clinics

*More disposal options for excess medications

*Additional scrutiny of controlled substances delivered by mail-order pharmacies.

Aetna’s approach

The health plan Aetna continues to identify its members who have a pattern of above-normal use of opioids and frequent emergency room visits and helps them to fight addiction with its Behavioral Health’s Medication Assistance Program, according to a Business Wire report.

Between January 2010 and January 2012, Aetna’s Pharmacy Misuse, Waste, and Abuse program was able to reduce opioid prescriptions by 14% among its 4.3 million HMO members. However, this excluded Suboxone, Subutex, and buprenorphine, the company reported.

For members with opioid dependence, Aetna’s team of nurses and psychologists help develop and track treatment plans. The Aetna Pharmacy Suboxone Case Review program was able to demonstrate a 30% improvement in opioid abstinence rates, a 35% reduction in hospital admissions, and a 40% decrease in total medication expenses, Aetna reported.