‘I don't want to take oxycodone anymore because every time I go to the pharmacy they don't have it, and they treat me like a drug addict," she told me from her hospital bed while holding the youngest of her two children in her arms.
Jane is a 40-year-old married woman, a veteran of the Marine Corps and a mother of two small children. She suffers severe abdominal pain from a large tumor in her liver. After several cycles of chemotherapy and surgery to remove the tumor, her cancer is still there. Looking forward to being discharged the next day, she was focused on finding a local pharmacy that would fill her oxycodone prescription after going home.
Unfortunately, her story is one that I hear from my cancer patients almost on a weekly basis. "We don't have it" and "We don't carry that" seem to be the new slogans in many Florida pharmacies.
As Florida officials have cracked down on "pill mills" — medical clinics that illegally and unethically distribute pain medications while masquerading as legitimate pain management clinics — the effort has hindered the legitimate use of these medications. As a result, cancer patients are finding it harder to get the pain medications they need.
Recent news that CVS pharmacies in Florida have blacklisted some physicians by refusing to fill their prescriptions for certain pain medications will only worsen the problem, not rectify it. CVS missed an opportunity to improve patient safety and health by working with prescribers to ensure that they are using the latest evidence and clinical practice guidelines for the management of pain. By "blacklisting" physicians, they're worsening the real problem: Too many people suffer from chronic pain and cancer pain is often poorly treated. My cancer patients are just some of the estimated 116 million Americans who suffer from chronic pain and are finding it harder to get the treatment they need.
The reality is that many health care professionals, including physicians, pharmacists and nurses, do not receive appropriate training in pain management and how to effectively identify risk factors or common behaviors associated with drug addiction. As a pharmacist, I understand these challenges and have an important role in keeping patients safe and their pain adequately treated. But if other pharmacies follow CVS's lead, the outcome will likely hurt all patients rather than addressing the problem of poor prescribing habits.
Some applaud CVS for potentially stopping rogue physicians from prescribing large quantities of oxycodone and other medications. It's an admirable goal, but CVS doesn't have the resources to thoroughly evaluate all of these medical practices. They would be better served by notifying the state medical boards about physicians practicing inappropriately or the U.S. Drug Enforcement Agency about physicians who are engaging in illegal activity.
The next day, when Jane was released from the hospital, she had not yet found a pharmacy that would fill her prescription for the oxycodone she needed to manage her cancer pain. What should CVS do? They should help patients like Jane spend her last days in less pain and be an advocate for improved prescribing practices.
David S. Craig is a Tampa pharmacist and a Mayday Pain and Society fellow.