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Community pharmacies and the drug wholesalers that supply them find themselves caught in the crossfire between people who divert and abuse prescription medications and the law enforcement officials working to stop them.
Recent action taken against CVS/pharmacy and Cardinal Health by the Drug Enforcement Administration in Florida is a case in point.
The DEA moved in early February to prevent two CVS stores in Sanford and Cardinal’s distribution center in Lakeland from handling controlled substances. The agency stepped in after it was discovered that the facilities were shipping and dispensing oxycodone and other potentially addictive medications that are sought after by recreational drug users in amounts that far exceeded the legitimate needs of the local population.
CVS and Cardinal challenged the ban in federal court. After the two companies won restraining orders that temporarily blocked the DEA from enforcing the ruling, Cardinal suffered a setback when Judge Reggie Walton of the district court for the District of Columbia reversed course and allowed the ban to take effect. (The CVS case was still pending at presstime.) In his ruling Walton found that Cardinal had a responsibility “in the first instance to self-police” when shipping large quantities of narcotic medications.
Hours after the decision was handed down the company indicated that it will file an appeal, while at the same time reiterating its commitment to combating prescription drug abuse.
The problem is widespread, serious and growing. According to government figures, some 7 million people in this country take prescription pharmaceuticals for nonmedical purposes and such medications, including opioids and antidepressants, cause more overdose fatalities than heroin, cocaine and amphetamines combined. Agencies at all levels of government clearly have a responsibility to address the problem.
The irony in the DEA’s action is that Cardinal and CVS have consistently demonstrated their commitment to combating medication abuse. In addition to investing millions of dollars in an advanced technology to identify diversions and maintaining a staff of specialists to address the issue, Cardinal has developed a program to train retail pharmacists.
Together with experts at the Ohio State University School of Pharmacy, the Cardinal Health Foundation two years ago introduced GenerationRx. The toolkit, which gives pharmacists the resources they need to educate patients and community groups about the risks of prescription drug abuse, is available free of charge on the wholesaler’s website. The original offering was subsequently updated with a version designed for young people.
CVS has also acted decisively to fight drug abuse. The company told a small number of physicians in Florida last fall that it would no longer fill the prescriptions they write for Schedule II narcotics.
“As reported by Cardinal Health, distributions of oxycodone to the two Florida stores have decreased by approximately 80% in the last three months compared to the prior three months — we believe in large part due to our action,” a spokeswoman for the drug chain said last month. “CVS/pharmacy is unwavering in its compliance with and support of measures taken by federal and state law enforcement officials to prevent drug abuse and keep controlled substances out of the wrong hands.”
Government agencies should be able to count on health care providers as they work to curb prescription drug abuse. As in the Florida case, they go off the tracks when they think private companies can solve a societal problem.
Setting aside that unrealistic expectation, government officials need to think long and hard about the unintended consequences of their actions. Retail pharmacies and drug distributors are in business to get medications into the hands of individuals whose well-being and, in some instances, very lives depend on them. Anything that disrupts the legitimate use of prescription drugs will adversely affect the health of those patients and lead to higher costs for their treatment. Solutions for medication abuse shouldn’t create new problems.
