Woman denied pain meds, new regulations to blame

http://www.bakersfieldnow.com/news/investigations/Pharmacy-trouble-303686261.html?tab=video&c=y

BAKERSFIELD, Calif. (KBAK/KBFX) – Jessica Barr loved gymnastics. But the sport didn’t always love her back.

“It’s like football, great sport when you’re not injured,” she said.

So, like many childhood gymnasts, Barr is paying for her time in the gym as an adult. She needed a knee replacement. And after shopping around for a surgeon, she chose one in the L.A. area.

The surgery went well, but pain is to be expected.

“When I got home, pain-wise it was about a 7 to an 8,” she said.

So Barr’s physician prescribed drugs for her pain – hydrocodone.  

“Once I took the pain medication it dropped down to like a one,” Barr recalled.

But getting the pills wasn’t easy.

“We went to Northwest Pharmacy first,” she said. “Then we went to Rite Aid. Then I called Hina’s and then I called CVS… everybody said their store policy is they do not fill out-of-town prescriptions.”

Frustrated, she called the Eyewitness News Tip Line.  

“People go out of Bakersfield all the time to have surgeries done,” she said. “I started thinking about all the people that might be encountering the same situation I was encountering and it made me angry.”

Why

Hydocodone was recently reclassified by the Drug Enforcement Administration. Controlled substances are assigned a schedule which determines what sort of regulations the government places on them. This year, hydrocodone is considered schedule two – similar to cocaine and Adderall in terms of its risk of abuse or dependency. 

“The state board and the DEA have cracked down,” said Pat Person, the pharmacist at Ming & H Drugs. “There are more hoops that a patient needs to jump through in order to get the prescription.”

“It becomes more stringent,” said Ty Stout, of El Tejon Pharmacy. “Not only on the patient, but also on the pharmacies and even the wholesalers and manufacturers.”

Both Person and Stout agree. The regulatory burden is heavy. The system isn’t perfect, but it’s necessary. Abuse is rampant.

“It’s not just a local problem,” Stout said. “It’s kind of like an epidemic problem. We see that nationwide.”

In an effort to get control of the problem, California has implemented an online database populated with information from doctors and pharmacists that allows prescribers and pharmacies to view all controlled substances residents have received in the last year.  

“The expectation is that California should be able to get ahead of these kinds of problems,” Person said. “It allows us to do a patient check.”

The database is supposed to stop addicts by giving dispensers a head’s up about their history.

“There are patients out there that we see that have gone from doctor A to pharmacy A to doctor B to pharmacy B to doctor C to pharmacy C, all within a 30 day window,” Stout said.

And if one such patient makes it out the door with drugs, the pharmacy could be on the hook.

“The state Board of Pharmacy has developed a plan called corresponding responsibility where pharmacies are now liable for the prescriptions that they fill for controlled substances more so than we used to be in the past,” Person said.

So when you walk into a pharmacy looking for hydrocodone, the state expects pharmacists to also give you a healthy dose of skepticism.

They’re advised to watch for a number of red flags: out-of-town doctors, out-of-town patients, people paying cash, doses that seem a bit too large, nervous patient demeanor, etc. Too many unknown variables will end the transaction for the pharmacist.

“If there’s any thought that there’s abuse or diversion going on there, we’re legally obligated to say ‘sorry, I can’t fill this for you,” Stout said.

The initial results of the crack down?

“We’ve seen a decrease in the number of deaths and the numbers of ER visits, accidental overdoses and deaths since the prescription drug monitoring programs have been put into place,” Stout said.

But the gains have come at a cost.

“Who does it hurt the most? Ultimately, it hurts the patient,” Stout added.

Help the pharmacist help you

If you go out of town for a procedure, get your prescriptions filled in the same city as your procedure – at a pharmacy likely to have a working relationship with your doctor.

Secondly, know your pharmacist. If at all possible, get all of your family’s medications from one pharmacist who knows you and your medical history. Let them know in advance of any procedures you will be having. That will eliminate some of the unknown variables when they’re weighing the decision to dispense the drugs.

And if your pharmacy shopping is really just about cost, speak up.

“A lot of pharmacies are willing to match prices or do something to help you financially,” Person said.

The other advantage to sticking to one pharmacy is that they might just save your life.

If you get several prescriptions from different specialties, it’s wise to have one pharmacist aware of all the drugs you’re taking. They may be able to prevent complications stemming from drug interactions the doctors couldn’t have anticipated if they didn’t know everything you were taking.

While our experts couldn’t speak directly to specific chain pharmacies, they said independent pharmacies will generally have more flexibility. Some corporations have standard policies governing schedule two drugs they won’t be able to compromise on.

One final suggestion, regardless whether you prefer corporate or independent pharmacies, is to be patient. The new rules for hydrocodone mean you likely won’t be in and out of the pharmacy in just a few minutes regardless of where you go.

Filed under: General Problems