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Tuesday, August 4, 2015

DEA ‘Pill Mill’ Crackdown May Be Causing An Unintended Consequence

Ten years ago, Chris Young was crushed by a car he was working under. “He was crushed accordion style,” says his wife Lesley.

Leslie and Chris Young. (Jessica Palombo/WJCT)

Leslie and Chris Young. (Jessica Palombo/WJCT)

The accident left Young, 45, almost completely paralyzed and in a wheelchair. He does have some sensation in his legs, but that is also where he experiences acute pain.

“It feels like electric shocks, like lightening bolts going down my legs and when it gets down to the bottom it feels like someone is driving a big metal spike up my legs,” says Young.

To control the pain, Young is prescribed high doses of narcotic painkillers. But since he has moved to Florida, he is having trouble getting his medications. His pharmacy runs out every month.

“They just do not have the medications because they have run out [of] their allocation within the first week,” he says. “It’s just that bad where I know I am gonna end up in the ER because I don’t have my medications.”

Young’s pharmacist is Bill Napier, who owns Panama Pharmacy in Jacksonville, Florida. Napier says since there has been a major crackdown on illegal narcotics, he can no longer serve customers who legitimately need painkillers. The wholesalers will no longer distribute the amount of medications he needs.

“I turn away sometimes 20 people a day,” says Napier.

Last year Napier was visited by Drug Enforcement Administration (DEA) agents who told him he was dispensing too many narcotics. They took all of his opioid prescriptions and held on to them for seven months. Napier hired a lawyer and paid for criminal background checks on his patients taking narcotics. He says he needed to satisfy the DEA.

“We’re being asked to act as quasi law enforcement people to ration medications,” says Napier. “I have not had training of rationing of medications.”

Bill Napier, owner of Panama Pharmacy in Jacksonville, Florida. (Jessica Palombo/WJCT)

Bill Napier, owner of Panama Pharmacy in Jacksonville, Florida. (Jessica Palombo/WJCT)

Until a few years ago, Florida was considered the epicenter for the trafficking of illegal prescription narcotics. The DEA and local law enforcement shut down more than 250 so-called “pill mills,” clinics where doctors could sell narcotics directly to people for cash. Now Florida doctors can no longer dispense narcotics directly to patients and wholesalers, which were also fined, are limiting the amount they sell to pharmacies.

Jack Riley, who is deputy administrator of the DEA, credits a decline in opioid overdose deaths in Florida with an upsurge in law enforcement activity. But he says these efforts cannot be blamed for any claim of rationing of painkillers.

“I’m not a doctor, we do not practice medicine, we’re not pharmacists, we don’t obviously get involved in that,” says Riley. “What we do do is make sure the people that have the licenses are as educated as possible as to what we’re seeing and that they can make informed decisions as they do dispense.”

The DEA has made it harder for doctors to prescribe narcotics. Last year, hydrocodone products, such as Vicodin, were changed to Schedule II status.

“What we’ve seen is dramatic reductions in our ability to provide appropriate care for our patients in pain,” says Dr. Sean Morrison. Morrison is director of the Palliative Care program at Mount Sinai Hospital in New York City. He says while law enforcement officials are trying to reduce the amount of illegal narcotic trafficking, legitimate pain patients are facing roadblocks in getting needed medications.

Morrison’s patient Ora Chaikin has been taking high levels of narcotics for years to control pain associated with bones and ligament destruction due to rheumatoid arthritis and other autoimmune diseases. But Chaikin who lives in Riverdale, New York, says her mail order pharmacy, Caremark, owned by CVS, has been denying her her medications.

“Every month there’s a reason they won’t give me my medication … you’re made to feel like a drug addict, like you are addicted to this.”

– Ora Chaikin

“Every month there’s a reason they won’t give me my medication,” says Chaikin. “Sometimes it’s ‘Well, why are you taking this dose?’ ‘Well, my doctor prescribed it,’ ‘Well, why did your doctor prescribe so much,’ ‘Ask my doctor — that’s the dose that works for me,’ and you’re made to feel like a drug addict, like you are addicted to this.”

Neither CVS nor Walgreens would agree to be interviewed. Both mega chains were fined by the DEA and paid tens of millions of dollars for violating the Controlled Substances Act.

In a statement CVS/Caremark said: “Per the September 2013 letter Ms. Chaikin received from CVS/Caremark’s mail service pharmacy, the prescribed dosage of her prescription exceeded the recommended manufacturer dosing. According to our records, since that time Ms. Chaikin has continued to receive her controlled substance prescriptions from CVS/Caremark without interruption.”

Ora Chaikin’s wife, Roseanne Leipzig, who is a geriatrician and palliative care physician, says when it comes to narcotics, there is nothing in the medical literature that says a dose is too high.

“There is no maximum dose for narcotics,” she says. “It’s the dose you need to take care of the pain.”

This story was produced in collaboration with Kaiser Health News

Correction: An earlier version of this story incorrectly identified the type of drug that was changed to Schedule II status last year. It was hydrocodone, not oxycodone. We regret the error.


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Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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