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."
"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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