Letter to the Editor of USA Today

As a practicing community pharmacist I read with interest the story on the fine agreed to by Walgreen’s Pharmacies. Since they agreed to the fine I assume that Walgreen’s agrees that they had a lack of control and has now taken steps to correct this oversight.

My concern is how the DEA spokesperson is so quick to point the finger at pharmacist’s oversight, wholesaler’s oversight but never seem to accept responsibility for the ultimate source of this problem. After all, which government agency licenses practitioners and enables them to prescribe these drugs in egregious quantities? Exactly the DEA! Who licenses the clinics that open? Exactly, the DEA! Who solicits from ALL of the major Pharmacy Benefits Managers dispensing data that shows who is writing these prescriptions? Exactly, the DEA!

My point is, why don’t they act on the entity that INITIATES the prescriptions? Because they are infringing on a physician’s decision making and that scares them to death! They are not physicians! By the time they get around to the obvious, thousands if not millions of prescriptions have been written.

Instead they pick the easy target, the community pharmacist. They question OUR judgment and give us ZERO opportunity to respond or explain why our decisions are made. They limit our ability to purchase medications. They threaten our suppliers if they don’t collect our patient’s private health data and turn it over to them.

We are being used as scapegoats for the meth craze and now the oxycodone explosion. The DEA is a typical bureaucratic entity that rather than solves the actual problem, would rather collect fines and pat themselves on the back publicly than listen to community pharmacists who MIGHT actually have some good ideas on how to address this problem.

Pharmacists KNOW who writes these prescriptions. In fact, a pharmacist friend of mine in Bean Station, TN lost his life at the hands of a drug head 2 weeks ago trying to do what the DEA expected him to do. We can point the DEA to rogue physicians. What we are not allowed to do, is play physician. How can we be SURE that a patient is a dealer and not a patient in real pain? One might say that you can tell by looking or that you can tell by the amount of the prescription but that is only true to a certain degree.

In the pharmacy in which I work we have strict protocols to determine whether or not to dispense. If it were up to our decision making process we would have removed hundreds of thousands of illicit medications from dealer’s hands. Instead when we turn them down they continue to go from pharmacy to pharmacy until they find one that is either too busy or slips up and gives them their medication. The root cause is the WRITING of the prescription. So instead of rewarding us for taking care of our patients they place arbitrary purchasing rules and squeeze wholesalers to limit the amounts that we can buy…whether or not we are following the rules. In turn this causes us to treat legitimate patients like drug addicts because we can’t get enough medication to fill their prescriptions.

It is like most issues facing community pharmacists today. The better we do our job the less we are allowed to do our job.

The bottom line is this…community pharmacists are the true gatekeepers of our emerging healthcare system BUT the “system” refuses to utilize us and pay us for the benefits we provide to our nation. We are not even recognized as a healthcare provider by Medicare so that we can be paid for providing services to our nation’s seniors. It is time to quit compromising our ability to do the job for which we have been trained. It is time for the DEA to quit squeezing those who want to be part of the solution and go after the obvious problem…the people that they license to write the prescriptions and begin the process.

I realize that by even commenting on this I place myself open to retribution but it is time to focus this debate on the real issue and not on the healthcare professional that places his/her life on the line everyday to make the right decisions.

** Copy and paste this link into your browser to hear an interview with Terry on this subject by the Pharmacy Podcast Network and Todd Eury

http://html5-player.libsyn.com/embed/episode/id/2369841/height/360

73 comments

  1. Jarrett Swafford says:

    This post needs to go viral!…As a pharmacist myself, who has previously worked for a large pharmacy chain and just recently branched out and opened my own independent pharmacy; I can say this is an issue that pharmacist in all facets of pharmacy battle every day….Terry does an incredible job in this post of stripping away the political jargon and revealing the simplistic nature and real villains surrounding this whole problem. In my opinion the DEA’s approach to battling the opioid abuse problem is like battling obesity by limiting the number of parking spaces they allow McDonald’s to paint in each of their parking lots…..this level of cuisine excellence is available on every block, eventually people will get their #3….supersized…..Terry is able to be necessarily blunt and defensive with his take and reflections on these issues while repeatedly portraying a honestly optimistic light in the role and responsibilities pharmacist face everyday serving their patients. He highlights a lot of essential points and facts that would make any other pharmacist, health care worker, professional, politician, or everyday novice reader stop and rethink this whole quandary we’re facing. With the Walgreens news story fresh on everybody’s mind, I believe Terry has chosen the prime time to address the culprits casting this dark cloud on our beloved profession. If ever there was a time for solidarity in our profession, it is now. In certain terms, we have buckled under the competitive pressure from insurance companies and seen our reimbursements dwindle to an unlivable levels in most cases. In the bigger picture, it seems we are fighting each other instead of fighting the forces of insurance companies and mail order pharmacy that are bent on slowly destroying the relevance of community pharmacy….independent and chain…. The writing on the wall says these issues facing pharmacy are headed down a path that are only going to get worse and lead to more drastic negative outcomes for us as pharmacist and our patients. I truly believe this is an issue that all pharmacist can rally behind, take a stance, and make our voices be heard. Together we can invoke change and spur a different mindset to the DEA’s idea of the best way to battle this problem. This is arguably one of the largest issues facing community pharmacy and the ripple effects could drastically change the way we dispense medications in an almost certain negative way. I’m going to share this post with as many of my colleagues and patients as I possibly can. I would encourage anybody and everybody else who is affected by these issues to do the same. Also I would encourage everybody to support and/or defend any public response this post may generate.

  2. Johnny Brooklere says:

    Terry and Jarrett you have articulated my thoughts better than I. This should be in every “letter to the editor” section of every trade magazine, pharmacy association magazine, pharmacy cooperatives newsletter, ….
    If the pharmacist should have known these were illicit prescriptions shouldn’t the doctor have known and shouldn’t the DEA have known. Were the doctors disciplined? Has the DEA made adjustments to stop this sooner like by stopping the doctor sooner?

  3. Jim Floyd. says:

    I totally agree with all of the above. I’ve been a practicing pharmacist for almost 50 years and I have never seen things as screwed up as they are now. Kudos to all of us who choose pharmacy as a profession and are willing to put up with all the crap to insure that our patients healthcare is first class.

    • Susan Martell says:

      I am very interested in “Pharmacy” as my niece just received her Doctorate in Pharmacy I have a concern that applies to seniors more than anyone else. I get my prescriptions at Walgreens. One month my generic pills might be a brown round tablet. Then the next month the same prescription might be a light brown capsule. I also have gotten green capsules and pink capsules. How on earth when I get older than I am at age 70… will I ever be able to discern that I am taking the correct pill at the correct time if they can change like that? Also, how can my children help me when they are not aware of the constant changes? Is it not a huge problem? I asked the person at the Walgreens counter and she said they try to be constant in their choice of providers but if they cannot get a drug from one provider, they will go to another one. And she said, yes, the size and shape does change.

      • Christine says:

        I really don’t think this comment is at all relevant to the topic at hand. The changing of your generic drug’s color/shape/size has nothing to do with the inappropriate dispensing of controlled substances. This problem happens at every pharmacy and we have almost no control which generic our warehouse gets. Please pay attention to your meds, know what you are taking and why and this problem can be minimized. When patients only know what drugs they take by size/color/shape rather than drug name, it creates problems for everyone.

      • Rph says:

        Ideally when they change there would be some notice given to the patient by the pharmacy staff, but if not Many pharmacies include the tablet imprint code (letters and/or numbers marked on pill) on the labeling to provide confirmation info, do not know if WAG does this or not. If not there are online pill identification resources available, one of the better ones IMO is a http://www.drugs.com, or another option would be to contact the pharmacy where the Rx was obtained and ask a member of the staff. You should never just assume anything about your healthcare, weather at the pharmacy, clinic or hospital, if you have a question, concern, or misunderstanding you should always feel able to bring it up, patients must start to understand and accept that they are the main variable responsible for their health, and better health and quality of life is dependent on a individual committing the necessary time, effort, and financial resource.

  4. Jerry Callahan says:

    I can’t agree more. We should send this to every newspaper we deal with and ask them to print this as well

  5. Benjamin Biller says:

    Very well said and true on all counts.

  6. Mukesh Patel says:

    I completely agree. Oue stress level is really high when we r trying to decide on oxy rxs. Up on refusal if we get robbed, killed or break in then who is liable for that?

  7. John S says:

    Something the DEA won’t do: Dr PAIN, you prescribe 10k times the narcotics your pears do. Effective immediately your DEA# is revoked. Your hearing is this Tuesday. PROBLEM SOLVED!

    • Retail pharmacist says:

      I fully agree!!! How is it a pharmacist will lose their license if we make poor decisions immediately? While doctors get to appeal and practice for at least 2 more years and write thousands of bad scripts? Hypocracy! Or they get their license suspended for a year and they are back with new DEA numbers and prescribing suboxone on top of it. They caused the problem with writing excessive narcotics now they turn around and treat you for the condition. It almost feels like a monopoly.

  8. John S says:

    peers.. .sorry

  9. Jenna P says:

    I am a 4th year pharmacy student and in school we had a colloquium about how to deal with a robbery at a pharmacy. It was good that they gave us the information so that when/if we are ever in that scenario we will know how to react. However, I think it’s sad that we need to do something like that. People don’t realize that pharmacists shouldn’t have to spend the majority of their time looking with suspicion at every narcotic script that comes through the door. We are trained to help our patients, not risk our lives to keep drugs off the black market simply because the DEA isn’t doing their job properly by not wanting to take a stand against the people who are the root cause of the problem. Pharmacists do play a critical role in this issue and I think we do need to be part of the discussion and solution but we cannot possibly catch every bad prescription every time. Yet the DEA is implying that by us not catching the phony scripts, we are the ones to blame. I guess they forget that we have other things to do in our day than just checking for fake narcotic scripts and identifying addicts and dealers. It’s always easier to blame someone else. They forget that the people they are blaming are also victims.

    • tforshee says:

      Exactly, Jenna. Oh, and what they told you to do during a robbery was followed to the letter by the pharmacist in Bean Station, TN. Guess what? He gave them what they wanted and complied in every way. Then…they lined he, his customers and staff up and made them kneel down and proceeded to execute them one by one by a shot to the back of the head. The only real answer is to give us the ability to make an intelligent decision instead of using us as a target because they are afraid to address the real problem. Oh, and that goes to Congress too, who have been given testimony in committee about what the DEA is doing and gave lip service in support. However, they refuse to act because the DEA says that what they are doing is working! Well, it is NOT.

  10. G says:

    Point taken. But what of the legit doctors and patients suffering due to the pharmicist’s decisions based upon fear of the DEA? The patients are the ones truly caught in the middle here…… I have received rx’s that were short pills, but told neither doctor or pharmacist for fear of being falsely labeled a drug seeker. Happened more than once at a local Walgreens. Have to wonder….what of those missing pills and how many others were shorted? Leaves a bad feeling all around.

    • tforshee says:

      I understand what you are saying. We do get patients that accuse us of shorting them but in my pharmacy we take a photo of every fill thru our automation system as well as a video feed. We NEVER assume a patient is lying. We know mistakes are made and if we do we always want to know. Please never ignore a shortage. I always want to get to the bottom of it. Believe me I understand the dilemma from the patients viewpoint and get frustrated myself. Communicate with your pharmacist! Just as you deserve their trust until proven otherwise, they deserve yours also. Best of luck and thanks for commenting.

  11. PW says:

    Very well said. It’s a true shame that this is what practicing pharmacy has become so much of the time. Pharmacists should not be the police of the narcotics war; It should be stopped at the prescribing step!

  12. A couple of months ago Nat Geo had a documentary on the DEA and the drug cartels have went from “fast boats” .. to.. semi-submerg boats to SUBMARINES.. and the DEA has come up DRY for nearly two years… guess what.. Congress is not going to keep giving them billions and billion every year.. if they don’t meet there charge… also.. wholesalers, Pharmacists don’t carry AK-47 and shoot at DEA agents… like the cartels do… we are the low hanging fruit.. and excellent documentation of what we have done.. A few years ago I read a statement from a DEA agent.. that Pharmacist CANNOT be 100% compliant.. the rules are too complex and complicated.

    I also had a DEA agent tell me – in person – that the DEA’s charge is not to prevent diversion… but to ARREST those that would divert drugs… unless drugs get to the street… the DEA has no purpose…

  13. Gerald Lawrence says:

    On the right track, just one problem. The probable reason that Walgreen capitulated was not guilt as that is where I work. It is that you just don’t mess with the DEA. I worked for a company owned by JCP and back in the 80′s one pharmacist said something and a DEA agent did not appreciate it. So we had to jump thru some hoops like WAG .
    I think tougher legislation on rx pads (like Texas) and coming down on the over writers is the best approach. I talked to my BOP and they are investigating 11 MD now with a highly publicized case (maybe 2 years) coming to a close ( MD and RPH and store).
    So no quick answer and yes in my 42 years (closing that out and now retired) I have maybe been tougher than most with the “god complex” and “if someone dies it will be your fault” just 2 of my favs , and my frustration goes to the MD.
    Now the company says we can refuse to fill which is something I have always thought was our right. In the past we could have been chastised by the company if we said “NO”.
    So yes as long as we are in a retail setting we are stuck between a tripronged pincher (MD, Corp, and DEA).
    Good luck to you younger folks as I think you are going to need that as well as GOD on your side.

  14. Stephanie says:

    I have been told by my wholesaler and an ex-DEA agent that they will not go after the docs because they have too strong of a union. Not that I agree with this on any level but maybe it is time for pharmacists to join together, contribute some money and send some lobbyists to Washington to protect OUR profession and the source of our livelihood!

  15. Charlotte Edmondson, Pharm D says:

    You are absolutely correct on all points. This should be picked up by national news!! I agree totally…

  16. FRANK WISHNIA R.PH says:

    THE ALLOTMENTS OF NARCOTICS IS HAPPENING ON A DAILY BASIS AND IS A REASON FOR ALARMING ALL AMERICANS.
    IT IS AFFECTING THEIR HEALTHCARE EVERY DAY AND DRIVING PRICES HIGHER AND HIGHER.
    HOW DO WE MAKE THE PUBLIC MORE AWARE. IF THEY TRULEY UNDERSTOOD (THRU A MOVIE, CONGRESSPERSON, OR MAINSTREAM NEWS CHANNEL), SOMETHING MIGHT GET DONE.

  17. Tom Garren says:

    Mr.Forshee you nailed it….It’s Dr’s. are the SOURCE of the problem…SOME Dr’s. are RAPEING the MEDICAL profession..They are charging these dope heads $300 to $400 to write a Rx for 180 oxy 30′s (they sell for $5,000 or $6,000 on the street)….Medicaid pays for the Rx at the Pharmacy….Pharmacy makes maybe $5.00….DEA, drug chain, Pharmacy Board puts the responsibility on THE PHARMACIST to decided if THE DOCTOR wrote a Legitimate RX in GOOD FAITH !!!!! Is that not a damn JOKE ?????

  18. Todd Pfeifer says:

    You argued the case well. I have listened to this argument , working in the field for years. I feel the best chance for change is people like you on the pharmacy board. You would be a great representative on the OK State Board of Pharmacy. You change systems from the inside out, one block at a time. The state board is a great start. I’m sure there are several pharmacists reading this that would nominate and vote for you.

  19. Jack peacock says:

    In Florida doctors are not required to any special training to write pain management. And we also dispense 80% of the oxycodone in the nation. I wonder why?

  20. Tom Garren says:

    Sorry.. I’m not from OK. I’m from Tn. The Meth capital of the United States !

    • Amy W Cochran says:

      Tom, you obviously haven’t been to Alabama lately. We have more meth arrests and meth lab explosions than anywhere else in the country! Especially in a little town called Boaz, AL.

      • Marc Thomas says:

        Frontline (PBS) did a great story on the meth problem. Oregon finally made Sudafed available by Rx only. The results were so successful an attempt was made to make it a Federal law. The pharmaceutical industry lobbied successfully to kill that idea. What an outrage! Where is this country’s sense of ideals and morals? 30 yrs as an rph and glad to see all this rumbling. Unions(yes)and go viral on the DEA.

        • Teresa says:

          I must tell you that as an Oregon resident and user of Sudafed, this law has caused a lot of problems for patients who need the drug for legitimate reasons (allergies). Now we have to get a doctors prescription every three months (at least that appointment is covered under my insurance, but not so for others), but 1) even though its a prescription drug my prescription coverage (Medicare, ODS) won’t pay for the meds; 2) only one pharmacy in my area (QFC) is willing to stock it; and 3) the price has at least doubled. Really silly as I could just cross the river into Washington state if I couldn’t get a prescription. I this this is a little bandaid on a huge wound that penalizes legitimate users. And I don’t trust the so-called results that Oregon is claiming in meth use/production.

  21. Paul B says:

    I love this letter and everything it’s trying to bring light to. I do want to point out that the DEA has spent years going after individual prescribers and it doesn’t make a dent in the problem. As soon as one “problem doc” is taken down, another one just steps in his/her place. All pharmacists know they have corresponding responsibility on all prescriptions we fill (I’m a pharmacy manager for Walgreens, and this phrase has been beaten into our heads the last few months)… Getting retail pharmacies to change the way we fill controlled substances will have a much larger impact on the epidemic than chasing individual prescribers ever will. In this way, Walgreens is definitely a scapegoat, not because they didn’t do anything wrong, but because everything they/we do is done by every other chain. I appreciate my company now telling me it’s ok to say no to filling an Rx, even it came at the expense of an $80mil fine.

  22. Lindsey Lee says:

    This hits home. And is so true. I am going to court tomorrow as a witness/victim in a case where I (and my coworkers) were held up at gunpoint for CII narcotics. I know how lucky we were that nothing more serious happened. It was definitely a life changing experience.

  23. I asked a state board inspector how are we to determine a Dr- Patient relationship? I was told it was our responsibility to figure it out. Sure, we call the Dr and ask is this Rx for legitimate purposes.

  24. Matt L says:

    Here is my view, from a Patients perspective.
    Over the last 10-12 years, my Lupus, RA, and multiple other disorders, seizures, etc, I have been prescribed an entire Pharmacy of drugs for my pain, Methadone has worked the best. Morphine makes me sick, Oxycodone/OxyContin doesn’t help much and lasts a very short time, and on and on. I’m almost ashamed, even after 6 years on Methadone, to walk into a Pharmacy for fear of people looking at me as a drug attic. About 4 months ago, someone came in my house through my garage and took ONLY my methadone, and another prescription that started with Hydro but wasn’t a pain medicine. They left iPads, TVs, etc. The local police, whom I know, looked at me like I was filing a false police report because only my medicine was taken, and not the other stuff. It was the middle of the day, pretty sure it would have looked a little obvious with someone carrying iPads, TVs, etc out of my house, but a pill bottle or 2 that fit in their pocket? I was almost to the point that I was going to do without my medicine for 2 1/2 weeks rather than getting a replacement prescription because I didn’t want to be label a druggie. Keep in mind, this was the first time n 12 years of having Narcotics this has ever happened. I went and spent $600, that I didn’t have, on a safe that I bolted into the concrete subfloor of my closet, JUST TO KEEP MY MEDICINE IN! I also installed 2 cameras and a DVR system outside my house for fear of them coming back when we are home, or it happening again and not be able to get my medicine. With all this said, I can’t agree more with everything said above. The SOLE problem is the DOCTORS. Why aren’t the doctors required to get your social and put it into a system every time you go to the doctor and see where you have been and for what over the last 6-12 months? They also should do AWAY with script pads and make a dedicated system for prescriptions. This way only a doctor can electronically send the script from a room recorded 24/7, where a fingerprint is required to access the system. This would help get rid of the fake scripts, make it easy to run a report of what EVERY doctor prescribes, and have a way to hold the DOCTORS accountable for what they wrote, and for who. I’m sure some people will scream privacy issues with having what doctors you visit being tracked and recorded, but if it saves a life by keeping drugs off the streets, it’s worth it. I also think it’s not long before Pharmacies are going to have 3 inch lucite plates between themselves and the patients, just like money cashing centers. Again, if it saves lives and keeps drugs off the streets, I’m all for it. And as an HONEST patient, I have NO PROBLEM with them taking my information and inputting it to a system to track where I go, and what I am prescribed. I think it will keep me even safer, then doctors will see what I am prescribed and have less chance of prescribing me a medicine that will interact with another one I am prescribed. Sorry for the book, just my opinion. And I get my scripts filled at Walgreens, and APPLAUD them for the extra steps they are taking to keep drugs off the streets! Now if only the DOCTORS will take half the steps Pharmacies take…

    • Teresa says:

      The problem with the “extra steps” by Walgreens is that as of last month (July 2013) I can’t fill much needed prescriptions for OxyContin TR and oxycodone 5mg that my son needs for severe, chronic pain, at Walgreens any more, because they’re not stocking enough of it and won’t special-order it. I finally got smart and realized that the hospital pharmacy 2 blocks away from our home should have it, and, indeed, have had no difficulty filling his last 2 prescriptions. Unfortunately, as I am physically disabled, that puts an extra burden on me as I now must go physically into the building to turn in the script, then return later, another trip, rather than using the Walgreens drive-through. This may not seem like much to able-bodied people, but for me this makes my life a lot harder. And Walgreens has been lying to me, too, about the reasons they’re not stocking these drugs, the reason for which I didn’t learn until I stumbled on these posts.

  25. MJ says:

    Thanks for the excellent post, Terry, and my sympathies go out to you and the rest of Stephen’s friends and family.
    In my experience, it isn’t just the DEA who is afraid to go after doctors…the state pharmacy and medical boards are just as bad. I had a case a few years back in a pharmacy I was working in where a doctor’s office was giving controlled substances to their “patients”, and our state Medicaid program was picking up the tab. On any given day, we’d get up to a dozen patients all presenting the same three Rxs from this office: Percocet (#60, take 1 BID…like that’s not a flashing neon sign that says FEEDING AN ADDICTION), Xanax and Soma. Identical strengths, identical quantities, identical SIGs. When I pulled up the prescriber histories, those were the ONLY Rxs we had filled from that office, aside from the occasional Ibuprofen Rx. No blood pressure meds, no cholesterol meds…hell, not even a few antidepressant Rxs from a family practice physician?
    I did what I was supposed to do: alerted the pharmacy board, filed a complaint with the medical board and faxed them the prescribing histories. Their “investigation” resulted in making the practice hire a pain management specialist…that was it. Not to mention, I got heat from my corporate superiors for refusing to fill the Rxs (“how do you KNOW they’re not legitimate?”), plus Medicaid never even bothered to respond to my tip-off of suspected fraud. The real coup de grâce, though, was that at any point in this whole s**t show, the DEA could have jumped in with both feet and busted me for violating the “Corresponding Responsibility” doctrine on any of the past scripts I had filled before I became aware of the problem.
    I get that retail pharmacies are basically the last line of defense in diversion control, but that doesn’t mean we should be the first to blame when things go south. The government either needs to start going after doctors with the same zeal that it does with pharmacies, or else they need to change the law to limit pharmacists’ responsibility to cases where we’ve knowingly allowed diversion or fraud to take place.

  26. kerry w says:

    14 years as a retail pharmacist and I have watched our profession go to hell in a hand basket. We have become multi-taskers of no less than 20 different responsibilities at a time on a daily basis from cashiering and taking out the garbage to counseling and trying to get MTM credit and catching drug heads all while trying to get the customer in and out in “McDonald’s-like speed.” Working 8 to 12 hour shifts sick with NO lunch break or a chance to pee and having our tech help cut to bare bones (can you say 0 to 15 hours a week? I don’t care how slow a store is, we shouldn’t be working by ourselves). I can’t even make a phone call to a patient or Dr. without 3-4 people walking or driving up all at the same time and then get nasty impatient at the 15-20 minute wait time. I guarantee I’m spending more time on making sure pt’s rx’s are correct and safe than the Dr. spent with patient! We try to keep the patients safe, that’s our job. And for most of us it’s our only job/profession. If we lose our license we’re screwed, we lose everything we’ve worked for. A Dr. can still practice without a DEA #, just not write for narcs, we can’t do anything. I don’t think the gas station is going to pay me the same salary. We try to keep corporate off our backs–God forbid we didn’t meet our quota of flu shots, MTMs, flavorings, rewards cards, patient calls, 90 day rx, blah blah blah… you’re gonna get a bitch out phone call by your DM at the end of the week. We try and alert the DEA when we feel the need, but then get scolded for smearing an MD’s reputaion. Threatened that we better fill those out of town oxy rxs then 3 years later told don’t touch them…
    We are OVERWORKED(too much on our plates)and UNDERVALUED. Scolded for doing the right thing and later scolded for not doing it. At the end of the day it’s all about how much money did your store bring in. And hardly ever a Thank you or a Good Job thrown our way. Bust butt doing a good job and they just say “fine…now do better, and more, with less help”….
    At least this is how it is in my neck of the woods…
    Don’t get me wrong, I love being a pharmacist, but I’m not encouraging anyone to go into retail. I think if the public (and government) really knew how things ran in the pharmacies and how we are treated they would be appalled. I hear all the proposals for the pharmacy profession that go to our state legislation and very few of them are to our benefit (in retail). We need to start sending proposals to cover our butts and better protect the public. Some of the state rules are too old and too vague and not many of them protect us. Remember in pharmacy school, we were taught “CYA” at all times because God forbid if one of us ends up in front of the Board for a mishap..they don’t care that “No one else could cover and I was sick as a dog working 12 hours and hadn’t eaten because it was so friggin busy and my customer’s health appears to be more important than my own….but I’ll catch that druggie next time…!!!

    • Apothecarrie1 says:

      I must be in the same ” neck of the woods as you”, Kerry. My husband, who is a detective for Metro Narcotics has always given me the wisest advice. He says “remember, if you must stand in front of a judge, or jury facing criminal charges for injuring, or killing someone, “I did not have enough staff” will never protect you. Not to mention meeting my quotas of MTM’s, flu shots, wellness calls, new to therapy calls, blood pressure checks, club memberships, flavorings, and 90 day rx’s with an ever shrinking staff, and oh, yeah, “how have YOU been developing meaningful relationships with you patients and community?”. In the face of these increasing pressures, the priorities WE set every day when we put on the white coat are the only ones that can protect our licenses–or destroy them. Choose wisely my friends.

  27. Monica says:

    Thanks to you!! As a tech of 20 years, I have worked in 2 different states and many different cities, only with 2 different companies though, and it seems to be getting worse everyday. The problem is everywhere! Not just the “ghettos”. I agree this need to be printed everywhere!!

  28. Jason says:

    I was taught in pharmacy school that to practice pharmacy, medicine, dentistry, etc, was a privilege, and not a right. Privileges maybe taken from you at anytime, without proof, because they are granted by the state, not a inherent right, like life, liberty etc. I have practiced with this in mind, and made sure that everything I do is above board, and in no way could even be considered to illegal. The boards have the legal power to suspend, stop, revoke, while they investigate those that have not made similar commitments. I fail to understand why some boards refuse to use it.

  29. Liz says:

    I agree completely with this post! Retail pharmacy is a joke nowadays. We spend our hardworking money and time in pharmacy school yet lose more than half the clinical knowledge we pick up while working in retail. Half the day is spent letting customers into the restroom, on the phone with MD offices/insurance companies, consultations, arguments with customers, prior authorizations all while checking scripts at a dangerous speed in order to avoid getting written up for not meeting certain “metrics”. We need the state boards, retail corps, and the general public to understand that retail is not McDonald’s and getting a food order wrong is trivial as opposed to giving a patient a wrong medication and making a life-threatening mistake. As for catching fake narcotic scripts and phony MDs, while some prescriptions are easy giveaways, many of them are not easily identifiable as fakes and holding a pharmacist liable for this is completely a mistake. As pharmacists, it’s time that we take our profession back!

  30. While I would really like to say yeah, WAG is finally getting an overdue comeuppance along with CVS, which already did, but I cannot. In reality, the DEA going after pharmacies for filling legal legitimate prescriptions by legal DEA LICENSED prescribers–you can’t write narcotic prescriptions without the DEA approving you and issuing you a DEA number–is a cheap, cowardly tactic that turns pharmacists into indentured Jr. Law Enforcement officers. If the DEA were more than just another intellectually stunted government agency it would take its otherwise failed “war on drugs” to the state boards of medical examiners and jointly go through and audit these doctors, systematically placing licenses on probation, suspension or fully revoking them. In short, in its current state of operations, the DEA has become a greater threat to public health and safety than any pill mill doctor ever will.

    Why? The DEA does the opposite, tying the Board’s hands, allowing prescriptions to be written and distributed amounting to hundreds of thousands of pills pouring on to the black market just so they can build a case and prosecute two to four people per case. For instance, here in Chattanooga the DEA spent nearly two years building a case against a local pediatrician turned pain clinic doctor. The clinic was cash only, bring your own MRI and the doctor himself even was writing prescriptions to people from Kentucky and the like out of his house at 3:00 in morning (that’s not a time typo)…and we all knew it because the dolts he wrote for would actually tell us when they got to the 24 hour pharmacy and then wonder why we wouldn’t fill the prescriptions.

    In the end, the DEA got him, his PA lackey and the two non-medical women who owned the clinic (and they had apparently been chasing since Florida). While there is a high probability none of the four will see less than a couple decades in prison, the piles of prescriptions the DEA allowed them to write in order to build the case is nothing short of irresponsible. And then to go behind and prosecute the pharmacies that filled the prescriptions written by a Board licensed DEA APPROVED narcotics prescriber? That’s the kind of conduct you expect from a cheap bully with too much power and too little brains; a process as far from intelligent and constructive as you can get without joining Congress.

  31. Hallie says:

    I agree. No pharmacy has medication for those who are in need yet some how the dealers can still get their hands on anything. So for the patients who are sick and in pain are suffering to run around for hours because no store will tell you over the phone and are left sometimes waiting and suffering or paying more because they have no choice. The DEA is driving the sick and wounded into the hands of the dealers because it seems no pharmacy has anything at anytime but the dealers have plenty. Explain that to me. My pharmacist tells me how awful she has it and how bad she feels turning those away who need it. She has patients that she has known for years and yet the DEA is turning them into looking and feeling like addicts or dealers which she has expressed makes her patients very uncomfortable. These pharmacies only receive a small amount a month and that’s it. But there is more then one person at each pharmacy that needs the medications. So now it comes down to luck if you make it there before someone else so you won’t have to be in pain. My pharmacy didn’t receive any type of pain medication for two months. She said her patients cried because physically they couldn’t drive around. Plus most pharmacies will only give to their patients when it comes to pain medications. So what happens when your pharmacy is getting the DEA treatment, well you are in pain and out of luck! The DEA is taking medications that work off the market because the companies have not paid them enough money yet the medications that are getting passed through the FDA and DEA have more side effects then the medical issue itself. Just listen to the commercials next time, the drug companies are trying to “sell” a drug. If the smaller drug companies can’t afford that you can’t afford to keep making the drug and its taken off the market (even if it was great and helpful). But Drs. get money and kickbacks when they sell a specific drug (not right) and can put your life in danger. It all comes down to money and control. We need to take our control back!!!!

  32. Kay Farr says:

    I totally agree with everyone here. I have worked for 36 years now and we are expected to do way too much in the amount of time we have. MTM, 90 day, New To Therapy calls, flavoring, health tests, immunizations, consult on all new prescriptions, do drive thru, take care of lobby, answer the phones, and fill prescriptions error free in between.

    The oxycodone explosion is the sole responsibility of greedy doctors who would rather take the money because it is the easiest way to make a buck. The medical profession should require at least an additional 2 year course in pain management and make it mandatory for all physicians would want to prescribe these drugs. And PA’s and nurse practitioners should not be allowed to write these drugs. Why doesn’t the AMA take care of this problem? I know their lobby is powerful but don’t they take an oath of DO NO HARM. The DEA is using the pharmacist, the wholesalers, and chain stores to control this explosion instead of going after the source of the problem…these physicians. Restrict their privileges and retire their licenses.

  33. John Rothwell, PharmD. says:

    Just like workers in insurance, the DEA has absolutely NO clinical background. They are handed a gun and a badge, and most often go after the illegal drug trade. Pharmacist spends much more time in school to learn clinical skills and judgement, but are not allowed to to arrest criminal offenders of presciption medications. The DEA SHOULD BE SPLIT INTO A PRESCRIPTION DIVISION, made up of Pharmacists and Physicians ONLY, that are also trained federal agents, to track down illegal presciption use. Simple as that. Let DEA Illgal go after the methheads and cocaine and potheads, and let DEA Rx hunt down shady doc-in-the-boxes and pain medication abusers, so that TRUE PRACTITIONERS can PRACTICE THEIR PROFESSION!

  34. Steve says:

    We have another problem here as well. These retail chains are building pharmacies to be more and more open making us even more vulnerable. The pharmacy chain that I work for has some ridiculous pharmacy designs..completely open with no protection or privacy for us to make phone calls to verify scripts etc. When I floated, I worked in some that were even more open than my home store. It was designed where someone could easily step over the swivel door which was located in the corner BEHIND where I stand. My view of the door was completely blocked by shelving too, so anyone who works here is vulnerable all day. Mix this poor design with the current oxy problem and you have a dangerous work environment. I’m waiting for the day that a pharmacist or technician gets hurt or killed and then the family sues these companies. I feel this is another issue that we need to put a stop to. The current pharmacy design by my company has absolutely no protection for the pharmacist and zero thought to patient confidentiality.

  35. Christine says:

    I couldn’t agree more. Thankfully, where I am, the DEA is actively investigating suspicious prescribers and has already shut down two of them. We have a long way to go, but at least it’s a start.

  36. Tony B says:

    My father and two very close friends are doctors, two close friends are pharmacists and I take their respective complaints to heart. My doctor friends are frightened to prescribe pain medication to individuals they honestly believe need it and my pharmacist friends deal with some over-prescribing doctors and some drug abusing and or drug dealing individuals. While there are crooked, system abusing members in both fields, neither profession is without its bottomfeeders, it is the honest patient with serious medical issues who suffers most, and of course this is due to the addicts and dealers who don’t care or understand the harm they cause. I have severe spinal issues and have endured a four level cervical fusion, only to still suffer from sometimes dehabilitating nerve pain. I also have rheumatoid arthritis and severe gout. I was prescribed powerfull pain meds for numerous years. I made a stupid decision to forgo all of the meds just to see if I could do it and to see if I really needed them. I found out pretty quickly I did need the medication to be able to perform my job and be a productive member of society. Unfortunately trying to get meds prescibed to me after my hiatus was damned near impossible. I was treatef like a drug seeking addict even with my accurate medical records. Believe me I understand your pain even while wondering if I can live much longer with mine.

    • Terita McCoy says:

      Right on Tony! I am suffering as we correspond here! Been without my meds since the 3rd of July! NO ONE WILL OR CAN HELP ME! I’m wheelchair bound if I don’t have my medication! Plus, it is a danger to stop these meds just cold turkey and the DEA knows this! I don’t know what is to be done. Even if I go to ER they cannot help either. Their hands are tied as to what they will or can do for me also! SO, My rights are being taken away and my health is being damaged because of all this BS! I have so many things wrong with my back it is a 3 page MRI! Nothing for me to do but suffer and I mean truly suffer. I stay in tears all the time because of the unbearable pain!

  37. Mark Corrales, DPh says:

    Just some food for thought….in the entire history of the DEA, has there been ANY decrease in the illicit use of drugs in America. It appears to me we experienced much less illicit drug use prior to their existence. Secondly, is there any evidence the DEA has made the drug supply in America safer ? I think not. In fact it appears to make the continued marketing of dangerous medications possible. I tend to agree with Ron Paul in that the DEA should be abolished and the relationship between pharmacist, patient and physician retorted to its natural order. The current trend is to attack the people “enabling” illegal activity rather than the actual perpetrators. Not just in our industry! When the government fears the people there is liberty ….when the people fear the government there is tyranny…..Thomas Jefferson.

  38. Christine says:

    I think the problem actually started with the push 10 years ago to treat pain like any other disease. In pain? Get a pain med. Prescribers were being reprimanded for NOT prescribing narcotic painkillers. So what happened? Everyone and their brother started writing for painkillers. Pain Treatment specialists started popping up everywhere and an epidemic was born. I’m in NY and I know a doctor that had the potential to lose her license because she refused to write for narcotics (because she felt they were not warranted) Then, because the patient complained to the State Board, she was reprimanded. For NOT writing narcotics! Insane. The government created this mess and now we pharmacists have to clean it up.

  39. ken says:

    A pharmacist union needs to be formed for those in retail. I have been saying that for years

  40. Gerardo Suarez says:

    As a son, granchild, cousin and friend of pharmacists, it is with great interest that I read this article. The DEA is barking at the wrong tree! Go fetch the doctors that write the questionable prescriptions, with transparency and courage. Go hunt them; no paperwork; no new rules; just hunt mean!

  41. I live in Europe (Italy) where the system is totally different and even more bureaucratized, though as far as I know we don’t have this kind of problem but believe me, we have other kinds! I find this situation in the USA fascinating and I’m not surprised your blog post has had such a huge response, it does sound like a real problem…Again, I suspect it’s not the amount of bureaucracy (more or less of it) that is going to provide a solution. It sounds like what’s needed is a total overhaul of the system, the DEA’s role and all related rules included . It probably needs to be re-thought…certainly a tall order!

  42. julie says:

    This post gave me chills and I applaud the job you do daily as an independent pharmacist. I work with independent pharmacists on a daily basis and I have nothing but respect for you and your profession.

  43. Devil's Advocate says:

    It appears that there is a lot if complaining about having additional responsibilities, yet nobody on here has suggested making less money to take on less responsibility. Also, stereotyping another profession and placing blame is NOT a solution. I’m sure there are bad patients, bad doctors, bad scripts, bad pharmacists, and even bad DEA policies. Changes need to be made in every aspect, and everyone needs to accept responsibility for their perspective professions. Pharmacists have always had a history of questioning doctors, but then don’t want the additional responsibility when it is given. Regardless, if pharmacists and doctors are put against one another then the patient and the communities will be the one hurt more. Stop casting blame and use that energy to alleviate the issue at hand. Or the DEA could just eliminate the pharmacy profession all together and hire techs to operate at government controlled facilities protected by armed guards and metal detectors, which I don’t think anyone wants including patients. Or the clinics could create their own pharmacies within the clinics and hire pharmacists to work for them, and then the physicians will take on all the responsibility from the government agencies. I can assure you that the docs don’t want that either… Everyone has complaints, those that chose to make a difference for the good of everyone and not themselves, those are the ones who will make a difference. Sad situation for all involved…

    • tforshee says:

      Honestly your comments are total BS. Who has said we won’t take on responsibility? I welcome the responsibility AND the $$ that goes with it. As for blaming doctors who is doing that? I blame the ones that charge cash only to write narcotics absolutely. I blame the DEA for tolerating it. Why should pharmacists accept responsibility for policing all of the problem? I make professional judgments all day and get paid NOTHING! So don’t come on here saying that I wouldn’t take a pay cut. To make any less I would have to pay someone. Get a clue about what you are talking about before typing.

  44. Todd Eury says:

    Terry – this subject & post needs pushed out to more pharmacy owners. I’d like to record and publish a special episode of the http://www.PharmacyPodcast.com Show as soon as your able. The markets & industry circumstances in wholesale deals, reimbursement, DEA targeting – all seems to be anti-Independent Pharmacy. We’re not making this stuff up.

  45. rkutchjm says:

    I am in total agreement with your article. The DEA has its hands into much stuff. They need to focus. Do a few things completely right rather than being overwhelmed with half-assed attempts to stabilize an out of control problem. Pharmacists don’t write the prescriptions. The wholesaler don’t write the prescriptions. Go after the source of the problem DEA that you license to initiate this process. Go after the primary tumor you ok’ed in the first place. Take the pressure off of yourself by taking cannabinol off of the Class 1 list.

  46. Todd Eury says:

    PHARMACY PODCAST Episode 94 MOST LISTENED TO SHOW (1-DAY) Over 2,350 Listens:

    DEA ATTACK ON PHARMACY
    Thank you Terry Forshee – for the interesting & powerful interview:
    http://pharmacypodcast.com/index.php/drug-enforcement-agency-attack-on-pharmacy/

  47. Becky, RPh says:

    Hope this editorial will help shed light on our current situation, but I am skeptical about anything I expect the government to fix. The government never solves the problem. It just creates 10 more unforeseen, unintended problems because there is no vision beyond next week. For example, what was solved by this fine to WAG? Will DEA proceed to fine or close every pharmacy that fills for these same practitioners that wrote the RXs that WAG filled. Now where are all the patients going with these prescriptions that these practitioners wrote? Is every pharmacy turning them away, and if so, what are these patients doing for the meds they are addicted to? Does the DEA think they won’t try to get them elsewhere? And if they are turned away elsewhere, what then? An addict will have to satisfy his need whether his has a legitimate source of pain or not. Is the DEA addressing any of these patients’ addictions? Is the DOCTOR addressing any of these patients’ addictions? Who should be addressing these patients’ addictions? Is the pharmacist who denies the prescription fixing the addiction? Or just being put in harm’s way? Will these patients go to the Dealers that they were once selling to? What happens when the Dealers run out? Will they rob the pharmacies? Will these patients move on to Heroin, (which is what is happening in our area since one of the Doctors has been shut down.) Has the DEA fixed the problem with this fine? Absolutely not!
    While the DEA is patting themselves on the back, they are creating an even worse problem because they are not addressing the right problem. There are addicts, some have legitimate pain, some do not. There are dealers posing as patients with pain to get their supply to sell. There are doctors writing to ALL these patients without regard to why the patient is in his office. And the DEA thinks the pharmacist is the one who should be policing this problem. The problem is much deeper than one fine to one company, who btw, was never the source of the problem.
    Now what? Our wholesaler is now saying they will be doing more cut backs on our supplies to appease the DEA. Last summer I was being limited so tightly that I would run out of most controls by the 15th of the month. You can’t run a business like that. My store is in a facility with 19 surgeons and that is 90% of who I fill scripts for. Well, surgeons primarily write for controls for post-op pain. I called my distributor to see what I could do but they said it’s the DEA that is causing them to limit me. Nothing they could do. I called the DEA and left 4 messages over the course of 3 months. Of course, no one returned my calls. Finally, I called my inspector at the SBOP. He said, “well it’s the DEA.” Nothing he could do. He gave me my district DEA agents cell number who called me back.(mostly mad that I had her Cell number) She said the distributer makes the guidelines to control the pharmacies supply. SO I called the distributor again. I had to speak to the man who writes the criteria for the DEA guidelines for that distributor. After explaining that my primary source of RX’s was from surgeons who have to write for post-op pain, therefore making my store an outlier of his typical protocol; he finally gave me higher limits. Now I’m afraid I’ll have to go through all that again, since they will be cracking down again to appease the DEA.
    The DEA is trying to take credit for fixing this oxy problem when they can’t even see the multitudes of problems they are causing with their so called solutions! And all the while, little Miss Jones won’t be able get her 30 Lortab from me for post-op surgery. Now that’s fixing it, DEA!

  48. Terry, after listening to the Pharmacy Podcast, I found your site. Excellent letter to the editor. You have verbalized and written my sentiments exactly. Only a gevernment bureaucracy could get away with finding pharmacists and pharmacies “guilty” of impinging on nonexistant law. An astute law professor once told me that feelings have no bearing in law, other than sentencing, and yet DEA officials can limit what we can purchase, fine us, and yank our licenses based on their feeling that we are dispensing too much, too many. DEA, please define “too much, too many.” Please show us in LAW what that means. Also, since pharmacists, by virtue of their licensure, dispense medication, please define for us, in law, how any pharmacist, once he or she has verified a prescription with a physician in good standing and licensed by you, SHOULD know that either a portion of a prescription or the Rx in its entirety will be diverted. By impeding our ability to purchase medication for our patient base, one could consider the DEA guilty of restraint of trade without due process of law, and there’s the rub~process of LAW. The abuse of powers given to DEA by the FED are woefully apparent in the industry. My business has lost 16% of our Rx volume since Nov. 2011 and that lost is DIRECTLY contributable to the actions of the DEA. I do not “feel,” I can prove the DEA has harmed my business, but worse, they have harmed my patients who have to scramble looking for medication because my allocation has been slashed again. The only way to stop abuse of power is either through revolution or court action. Perhaps we need both. If anyone is aware of an astute law firm that can grasp the injustice served upon community pharmacy at the hands of DEA and is willing to work on a contingency basis, I am willing to talk. I already have a target on my head, and if they shut me down because I am trying to exercise my right to judicial process, it only makes my case that much stronger.

  49. Pharmgirl says:

    To add insult to injury, how about AMA’s proclamation this week that pharmacists are wasting the doctors’ time and interfering with their practices when we call to verify controlled Rxs!!!?????
    This is beyond the pale!
    Pharmacists, we’ve GOT to unite and demand some respect!
    I’ve said this throughout my 32 year career but it’s never been more critical than now! Any ideas, Mr Forshee?

  50. Matt W, CPhT says:

    Please, none of you pharmacists will ever take back your profession because the retail chains you work for are paying you too much. I am a long time tech and you all have the power to take back your store. Too many pharmacists come in day in, day out just there to protect your license and collect a paycheck. The pharmacist I currently work under works under crazy workloads and still makes sure the patient is completely taken care of…. the metrics don’t even matter to the major chains if you have droves of customers actively calling in and singing your praises.

    • tforshee says:

      Touché. Until we prove you wrong I can’t argue with your assessment. Hopefully that time will come soon but as you say the proof is in the doing. Thanks for your comments from a tech point if view.

  51. Andrew says:

    It’s called the AMA. Largest lobbying power in the USA.

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