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12/1/2013 5:59:00 AM
Prescription drug quotas leave some living in agony
Prescription drug limits cause needless suffering, pharmacist says
Courtesy
Jay and Jean Fleming both suffer with chronic pain, but getting the medicine they need to keep it under control has become a nightmare, as pharmacists are limited on how many pain medications they can order and dispense each month.
Courtesy
Jay and Jean Fleming both suffer with chronic pain, but getting the medicine they need to keep it under control has become a nightmare, as pharmacists are limited on how many pain medications they can order and dispense each month.
DOUG McMURDO/Miner
The abuse of painkillers such as OxyContin, which has become a street drug widely sold on the black market, has placed an unprecedented crackdown on doctors who prescribe pain medication and the pharmacists who fill those prescriptions. Their patients suffer needlessly as a result.
DOUG McMURDO/Miner
The abuse of painkillers such as OxyContin, which has become a street drug widely sold on the black market, has placed an unprecedented crackdown on doctors who prescribe pain medication and the pharmacists who fill those prescriptions. Their patients suffer needlessly as a result.

Doug McMurdo
Miner Staff Reporter


Editor's note: This is the first in a series regarding prescription pain medicines, those who need them, those who treat them and those who fill their prescriptions. The series will also focus on those who are trying to address the growing problem of prescription drug abuse by people that have no legitimate reason to take them other than to get high.



KINGMAN - The war on drugs is no different than traditional wars. The number of civilian casualties is always far higher than are the losses racked up by combatants.

Cancer patients, people fresh out of surgery, car accident victims, longtime chronic pain patients and many others are going to their pharmacist to fill or refill a prescription only to find there are no drugs available to ease their often-intractable pain.

"It's a total disaster," said Ernst Kruger, a pharmacist at Mohave Health Mart in Fort Mohave. "I'm trying to work towards getting this resolved."

What needs to be resolved is the fact pharmacists have a finite limit on how many pain-killing drugs they can order and dispense each calendar month. They always seem to run out before the month is over.

Kruger believes 99 percent of pharmacists and the doctors who send pain patients their way sit back and wait for someone else to take care of the problem.

The issue, said Kruger, is that pharmacists don't know which government agency is in charge of quota limits - and they don't even know what that number is until they try to reorder a supply.

"Yesterday, I had a terminal cancer patient who burst into tears when I told her I couldn't help her," said Kruger.

"I wanted to say to her, 'This is the person who decided you don't need your prescription,' but I don't know who that person is."

Kruger said the common belief in the pharmacy community is that the Drug Enforcement Administration is the decision maker, but he's not positive.

Not only do pharmacists not know who is pulling the strings, they don't even know what their monthly allotment is.

"Nobody knows what the limit is. You don't know until you reorder and the wholesaler tells you, 'sorry, you've reached your limit.' There must be somebody I can talk to."

He said he's trying to work with everybody he can to restore peace of mind to patients, including doctors who prescribe pain medicine, the DEA and detectives who work on the Mohave Area General Narcotics Enforcement Team.

"I know (law enforcement) has a horrible job," Kruger said. "OxyContin, especially, has become a horrible street drug, so I don't really want to criticize law enforcement. They have their hands full and this is the reason we are limited. There's a horrible abuse problem in this county of ours, but what they're doing is equally horrible and the method is so haphazard."

The solution, as he sees it, involves law enforcement cracking down on doctors who run so-called pill mills, essentially selling prescriptions to addicts who have no pain - until they go into withdrawals after the pills are gone.

People who forge or alter prescriptions should be another necessary target, he said.

"Law enforcement should be really hard on these people, but don't put legitimate patients in jeopardy," he said.

For Kruger, telling a patient with a real need for pain medicine he can't fill their valid prescription is as heartbreaking as it is frustrating.

"I feel I do not serve patients the way I should because other people are making decisions for me," he said. "The bottom line is, illegal drugs are a real problem, but depriving people with pain of legal drugs is an equally serious problem."

Jay Fleming 62, and his wife Jean, 56, are two of those legitimate patients.

"People in pain who have a valid prescription deserve their pain meds," said Jay Fleming, a Dolan Springs resident who, ironically, was a narcotics detective for a number of law enforcement agencies until a serious on-the-job back injury forced him to take a medical retirement.

Both Flemings have experienced the nightmare of being without pain medicine because they were unfortunate enough to need a refill after their pharmacist exhausted his monthly supply.

Jay Fleming, in the throes of withdrawals and in unbearable pain not too long ago after he couldn't fill his prescription, said he seriously contemplated suicide.

The problem is compounded because, more and more, pain management doctors enter into contracts with their patients, said Jay Fleming, who injured his back and legs and also suffers with neuropathy pain in his feet. He describes the pain as "sharp, spiking jolts of agony."

He suffered his injuries in 1984. A failed back surgery four years later made matters worse.

"You agree to go to one doctor and one pharmacy," he said. "The contract is to guarantee you don't shop for doctors to give you another prescription and shop for pharmacists to fill them. I understand that and I have no problem agreeing to that, but what do you do when your pharmacist is out of what you need? You're forced to break the contract because you need your meds."

Jean Fleming, who has surgically fused vertebrae in her neck following a car accident in 1997 and surgery the next year, said she is made to feel like an addict.

"It's got to stop," she said. "I'm tired of trying to get meds and hearing the snide remarks."

She said while some pharmacists show empathy and genuine concern when they are unable to fill her prescription, others are less than compassionate.

One pharmacist who works in a Kingman supermarket, she said, actually joked about the withdrawal symptoms she would undoubtedly experience before he could reorder her medicine.

"With those kind of comments, how can you even trust them?" she said.

The Flemings say their doctors drug test them all the time, to make sure they are taking the correct dosage and not abusing the medicine or worse, not taking it at all and instead selling it on the black market.

Jay Fleming, the ex-undercover drug cop, believes 80 percent of people who take pain medications have a valid reason and a real need to take the drugs.

"Everybody is afraid of the DEA," he said. "The whole focus is on pain doctors, but we need to judge who gets medicine based on the risk versus the patient's needs.

"Thirty years ago, I crushed discs in my back and now they treat me like a damn drug addict."

Jean agrees.

"Neither one of us has ever been arrested. We've never been in trouble. This is terrible and it's not only happening to us. It's happening to every person in pain who has a legitimate need for meds."



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Reader Comments

Posted: Tuesday, December 31, 2013
Article comment by: Fight For Pain Care Action Network Inc

I am advocate in Florida and I knew this would spread to all other states. It's going to take as many chronic pain patients, caregivers, pharmacists, family members and doctors to start speaking out against this discrimination. I have tried contacting law firms to make a class action case but none are willing at this point.
The chronic pain patients are SUFFERING in this great country called America!
As for Oxycontin, this drug is not popular anymore on the steet because it's been made un-abusable and you couldn't give one away much selling any. The FDA said this at the conference last spring. I have been told by many legitimate patients that the Oxycontin has been ruined and doesn't even work anymore for long time pain patients. Most all of the pain meds are being ruined for legal use, meaning not as effective. Media needs to get the facts before writing.
Please everyone?? Fight For your rights to pain care! This is the USA and compassion used to be important here. 100 million people have chronic pain daily says the Institute of Medicine and more folks will know someone very soon who also suffers from pain. The population is largest ever so yes, we need more pain medicines. More folks die from NSAIDS and many other drugs other than opiates. Pls HELP and speak out.


Posted: Tuesday, December 17, 2013
Article comment by: This is Ridiculous

We need these stories to go beyond us to the nation. Everyone needs to know this is being done to us. We are all constantly having to deal with the pain, and now we have to constantly live in fear which makes our health much worse. We are treated like criminals when we have done nothing wrong. I didn't ask for this.

Despite what others may think, chronic pain is never ending. Unless there are cures for these diseases and new spines for people who have nerve damage, we will continue to have pain for the rest of our lives, and no one should have the right to sentence us to that. We are being tortured.

Every patient should have the right to get proper pain management. What works for one patient does not work for another. You treat your pain with your doctor as you see fit, and everyone else should have the same right. I would never judge another patient by what works for me.

There is no excuse for innocent people to be left in agony at the expense of a few.


Posted: Monday, December 16, 2013
Article comment by: susan allen

Walmart is the only place I can get oxycodone15mg for my fibromyalgia. CVS lies (they always say they are out and are having a hard time getting it. However, If i leave it anyway they call the next day and say it is filled) I had one honest small pharmacist tell me that he could only fill for a few clients due to DEA monitoring. He suggested I go to Walmart. NO problem there at all. Seems unfair to other pharmacists that Walmart can sell as many as they want because they are larger. I cant get them at smaller pharmacy even with my letter from pain management doc with diagnosis codes.. The added stress does not help pain. RX , Contract and letter should be sufficient anywhere..

Posted: Monday, December 16, 2013
Article comment by: GIGI Wingert

This control at pharmacies, it is only in certain states? I've never heard of this in CA.
Cat Lee: It is imperative that you not come off Xanax on your own. Sudden withdrawal from this medication, without medical supervision, can be dangerous and even deadly! I work in drug and alcohol addiction as a nurse and when detoxing our pts down from Xanax we oftentimes put them on Phenobarbital to prevent seizures. It depends on drug use history. You have to contact your doctor or go to a medical facility.
Pain Mgmt Provider: As an MD you understand the possibilities when someone is yanked off meds and the consequences. I would think that reasonable and cautious flexibility and understanding would be in order. I know many compassionate PM docs that are both and understand that there are sometimes extenuating circumstances, and function as such. I do understand the position you are in and the problem at hand, but believe that not making the pts suffer the consequences of the system is something you can help control.


Posted: Monday, December 16, 2013
Article comment by: Larry Bailey

I am 28 years old and I crushed 3 vertebrae in my back. I work every day. I've tried Togo doctors but they act like I'm should be perfect after plates and pins truth is I do hurt! All I want is to half way regular life without pain even some of the day! Last doctor told me I'm going to be in pain my hole life but also said drug laws tight I can't help you shouldn't even have pain in my because i did have the surgery Again I do have pain but because I'm young and do work everyday 50 hrs a week at that I don't get help?

Posted: Monday, December 16, 2013
Article comment by: Cyndi Chain

I live in New Mexico and this is also happening here. I'm sure it is everywhere. The only thing you can do is go to many different drug stores until you find one who can fill it for you. I tried calling and they will all say they are out. When I went into the pharmacy they filled it and I asked why they told me they were out . I was told that robbers do the same thing. Ask if they have any before going in and robbing them. This is crazy !!!

I am in chronic pain with three separate chronic pain conditions. I can't live without my pain medication.

Er rooms will be over flowing with us patients soon. If that doesn't help, there will be a increase in suicide.


Posted: Saturday, December 14, 2013
Article comment by: Jay Fleming

The problem is training, every doctor I've asked about paid training in medical school, said they got at most, a couple hours.

The AMA is so afraid of DEA, pain treatment, the number one reason people see a doctor, is not a recognized medical specialty.

We need a law saying a pharmacist must fill a lawful prescription, or find someone who will, isn't that what the court ruling on the day after birth control pill?

It's funny courts say a woman has the right to what she wants with her body, including terminate a child, but people in pain have no rights?





Posted: Thursday, December 12, 2013
Article comment by: Julie Thompson

[Comment exceeded word limit.]

Posted: Monday, December 9, 2013
Article comment by: Joe Miller

Sharon, my sincere condolences as it relates to your situation with your father. This so-called “war on drugs” has resulted in horrors to the average person and their families that overall far surpass those caused by the misuse of drugs. Wouldn’t it be wonderful if for this holiday season we all were decide to set aside our bigotries and prejudices and for once devote our efforts to actually easing the pain and suffering of others rather than ignorantly making matters worse?

Hugz, peace be with your family and father.


Posted: Sunday, December 8, 2013
Article comment by: Sharon L

My dad was diagnosed with stage IV esophageal cancer with 4 mo left to live. He was in great pain and in and out of hospitals. The doctors prescribed very "high octane" appropriate pain medications. It was the local pharmacy we had a problem with. Their concern is that my dad may become addicted to the pills and we had to constantly battle them. They put my dad and us thru hell with all the insensitive questions, bad attitude, rolling of the eyes, etc. I told the pharmacy it did not matter if he got addicted. They didn't like that answer. More questions, disapproving attitudes, and disrespect. Dad only lasted 3 months. Then the pharmacy found out and then badgered us about the few remaining pills that we had. Sorry. They were paid for. We were not giving them back to the folks who charged outrageous prices in the first place. The doctor is not the problem, it's the arrogant pharmacy who questions everything without the full knowledge. Just shut up and follow the doctors orders and dispense the pills. This pharmacy treated the entire family as if we were all addicts if we fought for my dad. I'd love for the paper to interview local pharmacists and have them answer some hard probing questions about this topic.

Posted: Saturday, December 7, 2013
Article comment by: Longevity By What Means

For the sake of those people who may still be relatively healthy, I wonder what the risk percentage is for people to die from their originally diagnosed ailment compared to the risk percentage of dying from the side effects (gastrointestinal, allergic, etc.) of the medication used to long term treat their ailment? Will a medical person like to respond?

Posted: Friday, December 6, 2013
Article comment by: Cindy Coats

I have also been on all these pain killers for years now..I know that i am addicted to them cause i wake up i feeling god awful. I will be moving out of the state of florida in the near fucture. I am scared of what is going to happen to when it comes to the withdraws. What if i can't find another pain doctor. Does anyone have any advice on what i can do about this? Also i have heard that you cannot just stopping take zanax. Because you will go into a seizures. Can anyone help me ? Please

Posted: Thursday, December 5, 2013
Article comment by: Cat Lee

conclusion:

I'd rather take my chances w/ narcotic pain relievers (i do take prescription nsaids also) & their level of danger than the virtually guaranteed death from my severe intractable pain, if left untreated--death either from suicide or my body/heart giving out (of which I am especially susceptible, since I already have a profound dysfunction of my autonomic nervous system, & my pulse & bp are already dangerously all over the place).

I have a feeling this issue is going to get worse before it gets better, but we all need to find a way to possess a voice in the matter.


Posted: Thursday, December 5, 2013
Article comment by: Cat Lee

Alan,
And guess what? NSAIDs cause more deaths per yr than narcotic pain relievers that # is apparently only from the stomach bleeds/gastrointestinal issues, w/ many more dying out of the 50k per year who have heart issues/attacks from those meds.

Where's the outrage, limitations & excessive legislation for THOSE meds? We would see consistency, as well as some compassion for those having difficulty obtaining their meds & having to dangerously go w/out (this is what should be illegal! talk about cruel & unusual punishment!), if their concern is about the loss of life, & not just about a seemingly desperate need to not allow anyone to get a legal "high" from their pain meds--which most of us with severe chronic pain rarely have an issue w/ (studies have shown that only as little as 3% of chronic users will ever have a psychological addiction issue, which is an entirely separate issue from the inevitable physical dependency these meds, & many other non-narcotic meds, create), & if so, it quickly & permanently dissipates. I'd have literally NO clue my pain meds were in my system if not for their pain reducing properties even then, I rarely drop below a 6 on the pain scale.

continued...


Posted: Wednesday, December 4, 2013
Article comment by: Fellow Man

Thank you pain management provider. The last sentence in your comment here restores my faith in doctors' true concern for my wellbeing ... at least, in SOME doctors. I would guess that either time or money / insurance may limit better care delivery to patients by many other doctors.

Posted: Wednesday, December 4, 2013
Article comment by: Me too

As a twenty year spinal cord injury patient. I can say more then once I've been let hanging out to dry without Meds. One doctor told me because he didnt do my surgery he couldnt believe my pain level. Shortly after he cut all meds off cold. It took me a year to get back to the management level I had prior.

I take 180 Lortabs a month. Without them I cannot function. I lay in bed in horrible pain and grit my teeth.

Thankfully Med Marijuana allows me to sleep a few hours a night. Im lucky to sleep more then 4 hrs at a time. Without smoking before bed. I wont sleep one hour solid at a time.

I sure hope I do lose the prescription due to this latest problem. I cant afford the dispensary prices to replace the script.


Posted: Wednesday, December 4, 2013
Article comment by: Healing Woman

A kind man told me, "no one can judge you for how you deal with pain." I have refused narcotics and synthetics for pain, been judged by doctors for getting emotional (tears) when I felt they refused to hear me, and have relied on alternative ways of healing. It is working for me! Adjusting what I eat (diet), meditation, self-hypnosis, mental outlooks, routine changes, herbal and vitamin supplements have helped heal me tremendously. Please consider the natural ways of healing that have worked for thousands of years to empower and help yourself. There is a balance possible between modern and old medicines. Become educated in alternative methods. Be kind and patient with yourself and others. Never give up, and don't depend on others to find your pain relief answer.

Posted: Tuesday, December 3, 2013
Article comment by: Pain every Day

There are obviously many people who do NOT understand pain management or the the horrors of chronic pain. I neither a *walking zombie* nor an addict. There are many combinations of methods to control pain.. pills being just one part of it. And YES some are only interested in taking pills. Insurances MANY MANY times will deny surgery or other treatments for chronic pain forcing patients to remain on pain meds. Where has the personal responsibility gone? It is up to the patient to UNDERSTAND and adhere to their plan of care. This problem is so much more complex then most people understand. I would GLADLY have surgery to relieve my back pain IF insurance would approve it! I WORK every day. If you are taking the correct amounts of pain meds to treat your pain..you will NOT be impaired (not talking about cancer patients)! Just because it says you can take it every 4 hours does not mean you HAVE to take it that often. I see both sides of this issue as I am in health care... and suffer from severe chronic back pain..and sometimes you just gotta suck it up..BUT the issue in NOT so black and white.

Posted: Tuesday, December 3, 2013
Article comment by: Care Taker

Thank you Doug McMurdo for addressing this long standing issue. As a caretaker I know firsthand that people with chronic pain do not want to take narcotics, get hooked on narcotics, nor be dependent on narcotics to improve their lives. However, until recently people with chronic pain had no other choice for relief. My husband has been disabled for the past 15 years. It’s been a long journey from one pain management clinic to another, but modern technology is beginning to address chronic pain and is looking for alternative solutions.

According to Jeanie Lerche Davis, writer for WebMD, “Today's pain specialists have sophisticated new treatments -- from effective drugs to implants and electrical stimulation -- to provide chronic pain relief. There's much that can be done to tame the beast. These advances have emerged in the past several years, as researchers have gained a greater understanding of chronic pain and how it develops.”

Maybe the DEA and health insurance providers should endorse alternative treatment therapies and spend less time harassing Pharmacists and Pain Specialists.

As for chronic pain suffers-- don't give up hope you should not settle for the same 'ol status quo health care. Do your research and ask your pain specialist about alternative solutions.


Posted: Tuesday, December 3, 2013
Article comment by: Jay Fleming

RE NSAID's kill 14500 people every year, not counting OTC. The patients bleed out through their intestines. It's a nasty way to die.

Tylenol kills 7000 a year.

Opioids killed 14800 last year.

I'm sorry people abuse these drugs, but don't keep medication from patients who need them.

If someone abuses drugs and dies, that's sad. If pharmacist withhold medication, and a patient is harmed, or comics suicide, that's criminal.


Posted: Tuesday, December 3, 2013
Article comment by: pl .....

@Thai Mai....yeah, and one of their puke-isms which really bothers me is "we don't make the law, we only enforce it". Aside from ignoring their blatantly illegal and lying offences in doing so, there's a good comparison with a fast-food establishment - the guy at the drive-thru hands you bad food and when you complain, he says, "Hey, I don't make the stuff, I just get paid for handing it to you".

Posted: Tuesday, December 3, 2013
Article comment by: Midwest Momma

It's not a good thing when you are treated like a hypochondriac when you are in pain. It is also not good when doctor's will not try to find the reason for your pain, tell you to take addictive drugs that you don't want and that will remain on your file. Treat the real cause, not the symptom! I wonder how many people in Mohave County could be pain free and healthy again if only the medical people would investigate what is really going on with their patients?!

Posted: Tuesday, December 3, 2013
Article comment by: pain management provider

As a pain management provider, let me say that we are not the root cause. We do not necessarily start patients out on narcotic medicines. when I do prescribe a needed narcotic, I always tell the patient that the medicine is hard to find, I offer an alternative non-narcotic and tell them if they chose the narcotic I am not going to change prescriptions due to availability issues. The patient makes the decision to have a narcotic or not. There are a few narcotic pills that are readily available and are not "abusable" but the insurance companies and government insurers will not pay for them.leaving us with limited pills to chose from. Hospice and cancer patients have different protocols for prescribing than those for chronic pain. Yes we have patients sign contracts. We also have a way to track every narcotic prescription for every patient and when we see the doctor shoppers we restrict their access to narcotics and sometimes refuse to prescribe. And yes, I get threatened with a law suit daily and have seen violence from patients/family members toward my staff when they do not get their narcotics. But I still go to the office every day in the hopes i can help even just one person,despite the accusations that I am a drug dealer with a license.

Posted: Monday, December 2, 2013
Article comment by: Not True

To "Dr's Cause This"....it is NOT true that you cannot get off oxycodone yourself. I am living proof.After a horrible accident and weeks in hospital many hours of therapy and many prescriptions of oxy I was tired of dealing with the run around to get mine filled. So, in two weeks time I gradually reduced the amount used until I was DONE and through it. No rehab no DR no nothing but a large dose of SELF RESPECT and intense desire to be free of narcotic drugs. I still have pain 24/7 but wouldn't take another oxy for any reason. It was wonderful having it to dull the tremendous pain at the time- but, you can live without them if you CHOOSE to. It's all your choice. I chose a more normal life and have never looked back. It CAN be done. Determination can bring any kind of change you desire.

Posted: Monday, December 2, 2013
Article comment by: Michaele Lee

First of all I am a chronic pain patient. I take meds everyday. I would challenge anyone to live with debilitating pain and have any enjoyment of life. My Dr. Is very strict. I get tested regularly to make sure I take the meds prescribed correctly. He always cautions me on the dangers and is probably the most responsible Dr in town. It should not be so difficult to get meds. Ive been taking them for 3 years. Im safe. I should not be punished because others sell their
pills. Its getting worse every month. Now pharmacies are not taking new patients. What happened to pharmacies just filling what the doctor ordered? Now you have to hope your pharmacy dont run out or you cant even go to another pharmacy. Its ridiculous.



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