Meredith Diaz’s battle against chronic pain has fallen foul of America’s new war on drugs.
The 35-year-old mother of three suffers from lupus, an inflammatory disease that causes bone loss and joint problems. She has a ruined knee that soon will need replacing, and herniated discs in her back. Until last year, Diaz, a nurse living on disability benefits, had no trouble getting the painkillers and anti-anxiety medicines — OxyContin, roxycodone and Xanax — her doctors regularly prescribe.
That’s now changed after regulators clamped down on Florida’s lax prescription controls to halt an epidemic of painkiller abuse that kills more people nationwide than heroin and cocaine combined. Drug distributors and pharmacies hemmed in by new regulations are limiting the pain medicines they keep on hand and who gets them, making Diaz and hundreds of other patients like her collateral damage.
“Regulation is fine, but truly making the pharmacists not able to get the medication can’t be the answer,” Diaz, who lives near Tampa, Fla., said in a phone interview. “There shouldn’t be this apprehension about how I’m going to get my medicine.”
In 2010, Florida harbored 90 of the nation’s top 100 pharmacies buying oxycodone, a synthetic opioid, according to a statement last year by Republican Gov. Rick Scott.
A year later, the amount of oxycodone sold in the state had dropped by 97 percent after a joint U.S.-state task force made 2,150 arrests for offenses ranging from improper sales to over- prescription by doctors. Last month, the Drug Enforcement Agency fined Walgreen Co., the nation’s largest pharmacy chain, $80 million for failing to properly control painkiller sales.
Pills doled out in Florida found their way into the black market, fueling a nationwide surge in prescription-drug abuse. Opioid painkillers caused 16,652 deaths in 2010, with more than 420,000 emergency department visits, according to the Centers for Disease Control and Prevention.
Sales of Purdue Pharma LP’s OxyContin alone accounted for about $2.81 billion of the $9.38 billion U.S. market for prescription painkillers last year, according to IMS Health Inc., a health care data provider based in Danbury, Conn.
While the Florida crackdown has been successful in fighting abuse, patients with everyday pain say it has also had a chilling effect on their ability to fill prescriptions that are legally obtained, appropriate and necessary.
In some cases, they say, pharmacies carry limited supplies that often run out, and some businesses only want to deal with long-known patients. New faces, particularly those from outside their immediate neighborhoods, are often not welcome, said Colleen Sullivan, 29, a muscular dystrophy patient.
That’s a particular problem for people who, like Sullivan, live in isolated areas. Sullivan’s home is in Marathon, a town in the Florida Keys with few pharmacies, she said. When they run out, Sullivan often finds herself traveling miles to find the drugs since pharmacies no longer will tell her over the telephone if they have a supply on hand, she said.
Paul Doering, a professor emeritus at the University of Florida College of Pharmacy in Gainesville, has worked with regulators on how best to control prescription use. Legitimate patients are in an awkward spot with drug sales now drawing strict monitoring, he said.
Distributors such as Cardinal Health Inc., the second-largest by revenue, are delivering fewer drugs because of both lower demand and concerns they may be blamed for any oversupply going forward, said Doering. At the same time, pharmacies that faced tough questions about outsized sales in the past now often refuse to provide the drugs unless they they know a patient’s background, he said.
“The hammer was dropped,” Doering said in a telephone interview. “There isn’t a material shortage of the drugs, but there has been somewhat of a de facto shortage.”
In some cases, he said, patients are being judged by their appearance by pharmacists who are concerned they’ll be blamed for providing drugs to the wrong person.
There is a solution, according to Doering. Before the anti-abuse task force, there was no easy way for doctors and pharmacists to verify prescription use. Now, health care providers must notify authorities every time a controlled substance is dispensed to patients and the information is recorded on a database.
Even so, state lawmakers declined to make use of the database mandatory and only 12 percent of doctors and 40 percent of pharmacists have registered for it, according to the Florida Department of Health. Pharmacists can find themselves having to confirm even legitimate prescriptions in a process that can take anywhere from hours to days.
“Because of the legal requirements placed on pharmacists to verify that controlled substance prescriptions are issued for a legitimate medical purpose, pharmacists may need to gather additional patient information from their prescribing physician’s office,” James Graham, a spokesman for Deerfield, Ill.-based Walgreen, said in an email.
The bottom line for patients including Diaz and Sullivan is constant fear that one day they won’t be able to get their drugs at all.
“It’s a very unhappy existence, but as a mother of three kids you don’t want to look unhappy,” Diaz said. “So you put on a facade. If I don’t have that medicine my life gets even harder.”