The Opioid Epidemic: Well, It Ain’t My fault … Maybe?

You can’t pick up a newspaper from the New York Times to the Tyrone Daily Herald, without coming across an article about the opioid epidemic.

There have been town hall meetings, letters to the editors, and front page stories publicizing this national emergency. From the mayors of our small towns in central Pennsylvania to the President of the United States, everyone has an opinion as to the impact of opioids on the lives of our citizens.

I was at such a meeting with our local state representative, Judy Ward, who is also a nurse. One member of the audience raised her hand and said, “We ought to sue those drug manufacturers. They created this problem.”  Without missing a beat, Rep. Ward pointed out there were two pharmacists in the room, and she would like to hear our opinions.

I began by saying, “You are absolutely right. The drug companies are at fault. Let’s sue them.” 

The drug companies will say, “We never sent out a bottle of our product to any warehouse that didn’t order it. Let’s sue the wholesalers.” 

The wholesalers can say, “We’ve never sent out a product to stores that didn’t order it, on a special triplicate form called a DEA 222!  Let’s sue the pharmacies/pharmacists.”

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The pharmacists can say “I’ve never ordered a bottle of narcotics that I didn’t need, and I needed them is because the physician wrote a prescription for them.  It’s the doctors fault. Let’s sue them.”

The doctors will say, “I’ve never written a prescription for a patient who didn’t need, in my clinical judgement, an opioid. It is the patients fault for being so demanding. Let’s sue them!”

I said I had witnessed the head of our local emergency department stand nose to nose with the Secretary of the Pennsylvania Department of Drug and Alcohol Programs.  He was saying that government patient satisfaction surveys were part of the problem in his area of practice. The government demands that the patients be happy and satisfied and giving many of these patient’s opioid prescriptions will make them happy and satisfied. So it’s the government’s fault. Let’s sue them.

I told the crowd, that this problem is so huge, that indeed there is enough blame to go around. Suing any one of the parties will accomplish nothing.

My son-in-law, Mark Garofoli, PharmD, MBA, BCGP, has the ominous task of attempting to make progressive changes at ground zero in the opioid epidemic, his home state of West Virginia. He coordinates an interprofessional panel of pain management experts including doctors, interventionists, pharmacists, and nurses with the goal of saving and improving lives by facilitating the shift of best practices in pain management to a new standard of care. Health insurance representatives on the panel are working to accomplish the same, which is contrary to typical situations in other states where insurance companies have reacted quickly and with the least amount of thought. Limiting a patient to 160 mg morphine equivalents (MME), who was using more than 600 MME/day just last month is simply ludicrous. That isn’t patient care. It is patient neglect.

Related article: How Independent Pharmacies Are Combatting the Opioid Crisis

Where do we pharmacists fit into the picture? We need to go no further than the Title-1 Code of Federal Regulations. Section 1306.04A states: a “prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.”

My son-in-law put it more accurately: “Dad, it’s only a sheet of paper, until you act on it.”

Count me in to be part of the solution!