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Tuesday, Jan 22, 2019
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Finger pointing won’t help on pain medication abuse or access

To hear of one family devastated by prescription drug abuse is to receive motivation to tackle the problem. Yet to hear a story of a suffering patient who cannot receive a needed pain medication serves as equal motivation to protect access. Both of these scenarios need to be addressed — simultaneously.

Unfortunately, the complex and intertwined issues of prescription drug abuse and access are not receiving the comprehensive approach that they deserve and require.

The reality is this: These issues require the insights and expertise of health authorities, law enforcement, patient advocates, prescribers, pharmacists and other stakeholders alike. All parties will not agree on every aspect of these topics, but their diverse perspectives are needed to create workable solutions. Those perspectives are not being leveraged today.

The organizations that we represent do not share identical thoughts. Yet we recognize that dialogue and true collaboration are necessary to achieve results that will benefit families, communities and patients alike. One of the many issues on which we agree is that the current culture of enforcement has not taken into sufficient consideration the needs of pain patients. For example, throughout the regulatory debate that led to new restrictions on certain pain medications, our organizations made the case that doing so would impact patients in real need of these medications to help them manage their pain.

That is just one example of the events that have shaped the current operating environment. Another example is the intense focus that has been brought on pharmacists and their decisions of whether to fill a prescription for pain medication.

Pharmacists are expected to not simply fill every prescription that is presented, but rather to help determine whether a prescription is valid and appropriate. The Drug Enforcement Administration mandates that pharmacists have a “corresponding responsibility” to do just that. This responsibility “corresponds” to the similar responsibility held by the prescriber. As a result of these regulations, pharmacists — like other practitioners — are expected to look out for “red flags” that may indicate that controlled substances are not being obtained for legitimate purposes. Unfortunately, this responsibility is not fully understood by most observers, and enforcement officials throughout the country are not applying these standards consistently.

The pharmacy counter has become the focus of this entire debate, because that is where the patient ultimately is receiving either a “yes” or a “no” as to whether the prescription will be filled. However, pursuing a zero tolerance for drug abuse and a 100-percent commitment to patient care — at the same time — requires collaboration that reaches far beyond that interaction between a patient and a pharmacist.

Our organizations are willing to contribute to that partnership. But true partnership requires still more collaboration from other parties

In Congress, The Ensuring Patient Access and Effective Drug Enforcement Act of 2015 (S. 482 and H.R. 471) would establish a framework to benefit from collaboration between government agencies and patient and provider groups. Without a concerted effort to bring enforcement and health care together to find a workable solution, problems related to drug abuse and access will fester.

Steve Anderson is president/CEO of the National Association of Chain Drug Stores. Paul Gileno is president of the U.S. Pain Foundation.

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