The Drug Enforcement Administration (DEA) recently made an appearance at a state pharmacy board meeting to appease pharmacists' fears of a crackdown on pharmacies.
The Drug Enforcement Administration (DEA) recently made an appearance at a state pharmacy board meeting to appease pharmacists’ fears of a crackdown on pharmacies.
DEA diversion program manager Susan Langston spoke at a Florida Board of Pharmacy controlled substances standards committee meeting about how the DEA has addressed the state’s prescription drug abuse problem, as well as the administration’s relationship with pharmacies.
Langston first recognized that patients who “needlessly suffer” from legitimate pain have faced obstacles in obtaining opioids.
“Your voices have been heard by the DEA loud and clear,” Langston said.
She asserted that the DEA’s intentions are to ensure that patients with pain are able to lawfully receive the medication they need. Langston also attempted to clear up some misinformation, which may be preventing patients from obtaining their prescription medications.
DEA Tackles the Pill Mill Capital
Florida, which some call the pill mill capital of the United States, has had a prescription drug abuse problem for many years. Langston highlighted that 11 Floridians die from prescription drug overdose every day during peak times of drug abuse in the state.
She noted that around 2010 to 2011, thousands of drug abusers flocked to Florida to get pills from rogue pain clinics that “had nothing to do with providing medical care.”
In many of these pain clinics, retail pharmacists were not involved in the dispensing. However, in 2011, anti-pill mill legislation shifted the dispensing of most pain pills to pharmacies.
Langston noted that this change afforded pharmacists increased responsibility. Most smoothly transitioned to this new role, but others got caught up in the pill mill world, she said.
“Unfortunately, there are still unscrupulous doctors and pharmacists in Florida,” Langston said.
The DEA began inspecting more pharmacies and saw both good and bad things occurring in stores across Florida. Among the bad were drug deals in parking lots, overdoses in pharmacy bathrooms, and pressure from pharmacy owners that led pharmacists to violate their oaths to do no harm.
However, these inspections also shined light on all law-abiding pharmacies, owners, and staff members who served a vital role in health care and developed good relationships with patients, Langston said.
“Most pharmacists are kind, caring, well-trained, and highly competent,” she said.
DEA Statistics on Florida Pharmacies
Many Florida pharmacists have reported fears of DEA pushback, which may have led some to be overcautious about dispensing painkillers.
Langston tried to eradicate these fears by reviewing how few pharmacies have gotten in trouble.
Of the 69,492 retail pharmacies in the nation that are registered with the DEA to dispense controlled substances, 4902 are located in Florida. Of these pharmacies, less than 1% have been formally sanctioned by the DEA, according to Langston.
Since 2011, the DEA has initiated formal processing to revoke DEA registrations from only 23 pharmacies in Florida. Ten of these cases are pending on administration hearings and final decisions, and only 3 Floridian pharmacies have ultimately had their DEA registrations revoked since 2011.
Langston said these pharmacies were ignoring red flags and contributing to prescription pain medicine diversion on a large scale. These pharmacies were involved in “unquestionable patterns of behavior,” rather than a few questionable prescriptions that fell through the cracks or a pharmacist having a bad day, Langston said.
Red Flags for Controlled Substance Prescriptions
As the final gatekeepers for opioids, pharmacists have a responsibility to prevent the diversion of controlled substances and must look out for red flags and drug-seeking behaviors.
Langston defined a red flag as a circumstance that seems out of the ordinary or suspicious. She recommended that pharmacists address red flags by asking the patient questions, calling the prescriber’s office, and using their common sense.
She said the DEA recognized that the majority of prescriptions for pain medication are legitimate, so if a pharmacist feels comfortable with an explanation of a red flag, then he or she should not have a problem filling the prescription.
Langston called for pharmacists to use their education, professional judgment, ethics, and common sense to avoid participating in the prescription drug abuse epidemic unknowingly. The DEA urges pharmacists to make concerted efforts to get to know their patients so that they can make informed decisions on prescriptions.
Langston showed a disheartened attitude toward a particular case of a patient named Aiden Lopez who was refused medication at several pharmacies. Aiden is a 4-year-old patient with kidney cancer who started chemotherapy this spring. His parents said they went to 3 different Walgreens pharmacies that all refused to fill his oxycodone prescriptions.
Langston called into question what drug abuse and diversion signs were present in Aiden’s case that 3 different pharmacists could not resolve.
“What drug-seeking behaviors could this 4-year-old possibly exhibit?” she asked.
She was deeply troubled by stories like Aiden’s, as well as anecdotes about regular customers who all of a sudden cannot obtain pain medication at their pharmacy. She said DEA inspections and actions should not interfere with patients getting the legitimate medication they need.
Many family members and friends of the DEA have been turned away at pharmacies for legitimate prescriptions, including her own family members, Langston said.
“This has to stop,” she said. “It has to stop now.”
Pharmacists Shouldn’t Fear the DEA
Langston said pharmacists who use their good judgment, experience, training, and common sense to fill prescriptions should not fear the DEA.
She reassured attendees at the Florida Board of Pharmacy meeting that there are no quotas or thresholds that the DEA creates related to what wholesalers sell to pharmacies or how many drugs a pharmacy can purchase or dispense.
Following Langston’s prepared remarks, attendees asked DEA spokespersons questions and provided their own perspectives. One attendee pointed out that pharmacists fear their good judgment and common sense may not be deemed the same way in the DEA’s eyes. He suggested that the board and DEA work together to create a basic set of protocols for pharmacists to follow when faced with prescriptions for pain medication.
Another board member noted that this was an opportunity for pharmacist education, and she suggested that “critical thinking skills” related to these issues be incorporated into training programs for pharmacists.
Both board members and DEA spokespersons agreed that their relationship should be collaborative, not adversarial. They also recognized a shared goal in both preventing prescription drug abuse and providing relief to legitimate patients in pain.