Pharmacists: Partnering with physicians to curb the national prescription drug abuse crisis

Editorial for Special Pain Section

Recent American Medical Association (AMA) resolutions addressing the increase in verification calls received from pharmacists about controlled substances describe such calls as “inappropriate interference with the practice of medicine.” These resolutions additionally call for legislative advocacy to stop pharmacists’ request for patient information when determining prescription legitimacy. While it’s important to note that the AMA is working closely with professional pharmacy organizations, including the American Pharmacists Association, to address concerns, it’s equally imperative that we understand the events leading up to this impasse.

For nearly a decade, Florida has been recognized as the “pill-mill” capital of the United States. Efforts by law enforcement to combat this plague largely failed prior to the establishment of the Florida Prescription Drug Monitoring Program (E-FORCSE). “Pain management” clinics thrived, and millions of doses of the drugs oxycodone, morphine, hydrocodone, hydromorphone, methadone, and alprazolam were prescribed and subsequently dispensed at local pharmacies. As Walgreens is the nation’s largest pharmacy chain, inevitably many of these local pharmacies were units of Walgreens.

In an unprecedented move, DEA in September 2012 halted shipments from the Jupiter, FL–based Walgreens distribution center and suspended registration. DEA cited “failure to maintain effective controls against the diversion of controlled substances into other than legitimate medical, scientific, and industrial channels.” Furthermore, the Settlement and Memorandum of Agreement (MOA) between DEA and Walgreens cited alleged “dispensing … of controlled substances to individuals Walgreens knew or should have known were diverting controlled substances …” Among other stipulations of this MOA, Walgreens agreed to implement numerous policies and programs that ultimately ensure that controlled substances only be dispensed for a legitimate medical purpose or by a practitioner acting within the usual course of medical practice.  

Coincidentally or not, prescribers across the country began receiving notifications from Walgreens regarding their “good faith dispensing” program and associated requests for additional information to help pharmacists fulfill their “corresponding responsibility” that prescriptions for controlled substances were issued legitimately and for legitimate medical purposes. As both a pharmacist and a prescriber, I found these calls to be cumbersome in everyday practice. However, often these calls stemmed from significant concerns these pharmacists had regarding red flags for aberrant drug-taking behaviors, misuse, and possible diversion of controlled substances. Potentially problematic has been the highly variable pharmacist interpretation of this program within Walgreens.  

But what is Walgreens to do? If we, as a profession, hold a corresponding responsibility for the outcomes stemming from the dispensing of these dangerous drugs, do we not hold a corresponding right to the patient’s medical information beyond a medication list?  

This country faces a daunting battle of preventing prescription drug abuse while maintaining access to these analgesics for patients in pain who so desperately need them. While the events leading up to the AMA’s proposed resolution are indeed unfortunate, both professions need to realize the important roles each has in the stewardship of these medications.