Chronic Pain Health — 25 June 2012

If you were in chronic pain and needed oxycodone, how much would you be willing to spend for a vial of the painkiller?

A hundred and forty dollars? Eight hundred? How about $1,250?

Those were the prices offered to a 50-year-old Florida man — not by drug dealers lurking in some dark alley — but by licensed pharmacists who may be profiteering from people with pain.

Scott, who asked that we not use his last name, wasn’t treated as a patient with crippling pain when he tried to fill his prescription. He was treated as a common junkie and a criminal.

Scott’s story is not unique. Millions of Americans in chronic pain are finding it harder and more expensive to get their prescriptions for opioids filled. The problem is particularly acute in Florida, where state regulators and law enforcement agencies have shutdown hundreds of pill mills, pain clinics and pharmacies to combat prescription drug abuse and the diversion of opioids.

Faced with the very real prospect of being audited or even prosecuted, many Florida pharmacists are reluctant to accept new customers needing opioid medicines. Some won’t fill prescriptions for patients who live outside their geographic area. Others refuse to accept insurance payments and will only take cash. And some, apparently, are only in it for the money.

Scott’s Pharmacy Crawl

Last September, Scott’s drunken neighbor smashed his shotgun into Scott’s knee during an argument. He immediately went to a hospital emergency room but received inadequate treatment. Scott obtained a referral to a pain clinic, but walked away when the clinic demanded $800 (lowered from $1,200 because he had no insurance) to see the doctor.

Unable to find a physician locally, Scott made an appointment with a physician recommended by a friend. This required a 200 mile round trip to West Palm Beach, but Scott was so desperate for pain relief he made the appointment.

The doctor prescribed oxycodone – 120 pills in 30 mg tablets. Scott was told by the doctor to break each tab into four pieces so the prescription would last for three months. I imagine this was recommended to save Scott the physical discomfort and financial burden of the monthly round trip.

Scott tried to fill his prescription in his hometown but was repeatedly turned away by pharmacists. One told him they no longer carried oxycodone; but if they did, they’d charge him $140. At two other large chain pharmacies Scott was also turned down – after being quoted prices of $158 and $180.

Scott tried a local discount pharmacy that didn’t accept insurance and was told he’d be charged $1,250 for the oxycodone – but only if he supplied them with his medical records. When Scott disputed their need for his records the pharmacist told him, “Get the f**k out of our store.”

“Go to your drug dealer”

The following day Scott went to the last remaining local pharmacy, where the woman behind the counter laughed at him and said that the medicine would cost $800 in cash, no insurance.

“Why don’t you try a street vendor?” she said.

“What?” Scott asked incredulously.

“Go to your drug dealer,” she advised. “But if you come back with the $800, we’ll take care of you.”

Scott, wondering who the real drug dealers were, wisely left.

This went on for weeks with Scott simply having to bear the increasing agony. At home taking care of his invalid father, Scott had to climb 14 stairs several times a day to assist him. Scott would sometimes cry from the pain in his knee as he ascended the stairs.

The pain was so bad Scott went three or four days at a time without sleeping. His misery worsened and a viscous circle set in.

He told his physician at his next appointment that “I’m in sheer agony. I can’t sleep or sit. I’m screwed no matter what I do.”

The doctor gave him a new prescription – the time for only ten 30 mg. tablets. He was told he could only fill the script at pharmacies within five miles of his provider. Within that radius, Scott went to and was rejected by all 11 pharmacies.

“I got to the point where I wanted to shoot myself or cut off my leg.”

In one last attempt, Scott went to a chain pharmacy where he was told, “Your type of person won’t get anything filled here.”

Scott has long hair and tattoos and believes he was constantly profiled by the pharmacies and found wanting. He felt defeated.

“I never got the chance to see if the oxycodone would have worked for me,” Scott said.

By December, the pain in Scott’s knee began to subside, but it didn’t erase the three months of torture inflicted on him by a distorted health care system.

The real cost of oxycodone

After talking to Scott I contacted a CVS pharmacy in centra lFlorida and asked what they charged for one 30 mg. tablet of oxycodone. I was told they couldn’t supply that information. I obtained no response from their headquarters either.

The cost of oxycodone varies from state to state and many pharmacies are reluctant to discuss what they charge patients. But Vermonthas a law that requires pharmaceutical companies to publicly disclose their wholesale prices. According to this report, the wholesale cost of a vial of 120 30 mg oxycodone tablets would be anywhere from $172 to $294.

Obviously, that’s not anywhere near the $800 or $1,250 that Scott was quoted.

Price gouging and other problems are so widespread among people with pain in Florida, one wonders when the state pharmacy board and legislators will acknowledge that the war on drugs has turned into a war on patients. They need to write regulations forbidding pharmacies from turning down legitimate pain patients with perfectly legal prescriptions and prevent those pharmacies from financially gouging the least powerful among us. Lastly, they should be required to accept patient’s insurance.

It’s time to declare a truce in the war on patients.

Mark Maginn

Mark Maginn lives in the east bay of San Francisco where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog can be found here

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About Author

Mark Maginn, Columnist

Mark is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation.

(10) Readers Comments

  1. I was never told to pay a high price for my oxycodone in Florida, but I have been rejected by pharmacies when I present my perscription. I wish these pharmacies would give this medication to patients with a valid perscription…PLEASE. I’ve been to seven Walgreens in one day trying to get my script filled. I thank the kind pharmasists who did fill my perscription bottles; but there are a bunch of cold hearted bastards who lie to your face. I have a permanent disability and I need the oxycodone to keep me working. Disability benefits pays too low, so please respect the fact that I am a hard working man who needs this medication to survive, not sit on my ass to get high all day.

  2. The situation in Florida is now utterly insane and inhumane. Because of the fear and hysteria brought on by the DEA and other special interest groups hellbent on the war on prescription drugs it is almost impossible to find a pain management doctor who is not thinking of giving up his practice for fear of losing it. The pharmacists fear they will lose their license if they fill any Schedule II prescription and they are limited on the amount of Schedule II medications they can fill. So they turn away the majority of patients with these prescriptions. They can turn you away if they don’t like your hair color. The legitimate pain patients are left to suffer because they can’t be sure from month to month if they will find a pharmacy to fill their prescription, which adds an incredible amount of added stress which increases their pain. The legitimate patient used to be told to go to one pharmacy only so as not to be seen as pharmacy shopping. Now, the two largest pharmacy chains in the state have policies against filling Schedule II pain medications. So, what’s left? Independent or “Mom and Pop” pharmacies. Some are told they won’t take insurance, only cash – at exorbitant prices. The only people who can afford these prices are the drug dealers. So, how is this system working when every patient is suspect, all are profiled, most are denied and more and more are being treated like criminals? Nobody can live like this for very long. You can’t expect people in pain to traipse around each month to tens of pharmacies just to be told “no” time and time again and month after month. People are suffering and it is getting worse every day. People who are in intractable pain who are left without adequate pain relief will commit suicide just to have the pain taken away. Some already have. How many people have to die needlessly before someone stops this inhumane attack against legitimate pain patients? They suffer hard enough as it is.

  3. I just want to say thank you for putting this article together and letting people know what is really going on. I suffered from this first hand wednesday when I went to fill my scripts. I went to the same pharmacist I went to last month who took my insurance. However I am now on medicaid because of ssdi. so when I entered she told the tech that I was fine she remembered me but oh no she did not. She said hello while grabbing her calculator. Turned to me and said the dilaudid are $4 a pill so that one script will be $674. I said uh I have insurance and her face dropped and she said oh ok give me a few hours like last month. Then I told her my insurance changed and I told her medicaid. Her face lit up as she told me that they do not take medicaid for that type of medication. She proceeded to tell me that medicaid does not pay enough and it costs the pharmacy and that is why. I asked her if medicaid knew this and she just stuttered. I am a 28 year old mother who only desires to not be in pain, to not hurt, to walk, and sleep and live like I use to but those days are gone. I have severe tremors all over my body. Cervical stenosis, two herniating discs in my neck, bony spurs all over my cervical spine, in my lower back I have two torn and two buldging discs as well as degenerative disc disease. I have neuropathy and that causes pain all over my body whenever it chooses to strike that feels like someones grinding and stabbing me down to the bone. I get muscle spasms every where even my face that feel like charlie horses. And numerous other problems. I did not choose this and its not fair what I and others are going through! It needs to stop now!

  4. In response to the comments below, from what I have witnessed myself, MANY legitimate pain patients were and are very hesitant to say, rock the boat, or get a pharmacy angry with them…Pharmacists at this point have a lot of power, wanted or not, and one little flag in the E-Force database, and they can kiss goodbye any chance of getting adequate medical treatment because some pharmacists got irritated they were reported. To make a report against a pharmacy, at least in Florida, you have to provide very detailed information, patient details, which considering the climate in Florida and the apparent abuse of power by many (healthcare, DEA, LE, etc), leaves patients very unwilling to stick their hand up and and say what is really going on. No one is paying attention to what is really happening to the REAL patients….just a lot of back slapping saying yeah we got the problem under control–WRONG–they have made addicts even more dangerous and desperate, following patients out of stores and to their homes, for example. I personally had to hand over a BINDER of medical records, which they KEPT, before they would CONTINUE (after at least five years of filling same prescriptions) keeping me as a ‘customer’. I cannot complain too loudly–I at least get most of my medications, although the pharmacy has decided how much of each medication I really need. But who are we going to complain to? Not to mention even how horrible I was treated by one of the techs, I just have to basically take it…and be grateful. No one should be judging who needs what medication, except for a certified doctor–yes there were MANY that took advantage of the lax laws here in Florida, but with all these tactics enforced these days, why am I (and other patients) having to explain my 12 years + journey of pain, bone infections, nerve damage, multiple surgeries, etc…WHY do I have to INTERVIEW and explain my condition to someone who is NOT a DOCTOR!….

    sigh, sorry, yes a little venting but this problem is only getting worse…and I fear my life will be much shorter then I thought it would if it gets any worse. And again, I am one of the LUCKY ones that is usually able to get my medication; I cannot even imagine what state of mind I would be in if I had to do the Pharmacy Crawl every month.

  5. Great article, its sad too,medicaid isnt accepted at pain doctors,and most of us dont have a choice,but to pay cash,florida needs big changes,as we barly have the drug let alone doctors or pharmacies willing to perscribe it anymore of fear of the dea

  6. Another GREAT ARTICLE! Thank you for exposing what is happening through-out Florida, as well as many other states I am sure. This is a REAL problem, and is a REALLY BAD problem–legalized drug dealing is what is going on. This has to stop! Thank you Mark!

  7. I totally agree Unhinged. There are many individuals with chronic conditions being descriminated against. While I am glad that someone is writing about the issue I do not feel this story fits into the real issue regarding CHRONIC pain patients.

  8. I agree with both of you to an extent. As I said in the column, I think that the physician, trying to be helpful, gave Scott the amount listed as a way to forego Scott having to travel 200 miles round trip. It does point out though what I see as a failure in physician education about pain. I wouldn’t have prescribed that many oxycodones to Scott. In fact, as he couldn’t get his script filled, he suggested to his doc that he write the script for only 1o tabs, which was imminently reasonable. To restate what was said in the column, Scott was in awful pain leading to sleeplessness, thoughts of mutilation and ultimately suicidal ideation. But even with the reduced number in his last script, Scott couldn’t get any pharmacy to fill it. Regardless of the mistake by his doctor, Scott was legitimately in severe pain. I don’t agree with Barb’s comment about this med not being appropriate for an acute injury. Knee injuries can be horrendously painful, I know this from personal experience, and if I was in Scott’s position I would have asked the doc to keep experimenting with dosages, strength and yes, if necessary, different meds, including oxycodone if that worked. There might have been other options available to Scott-massage, acupuncture, physical therapy-but as was stated in the column, Scott had no insurance to cover these treatments. This just shows the complexity of diagnosis and treatment for severely painful injuries.

  9. Thanks, Mr. Maginn, for being a member of the media who acknowledges that the current “war on drugs” is instead, a war on pain patients. I must admit, though, that the specifics of THIS story seem a little odd. What doctor (in today’s climate) would write a prescription for 30 mg. Oxycodone tablets, to a patient with an undiagnosed, acute knee injury?! When, 30 mg. tablets of oxycodone have a high abuse potential, can be fatal in patients who are not opioid tolerant, and have the highest street value. Regardless of the doctor’s instructions, this seems very odd. Unless, of course, this doctor knew exactly what he was doing, in that, he KNEW no pharmacy would fill the prescription!

    My point is only that, there are THOUSANDS of stories about pharmacy price gouging, unwillingness to fill legit
    prescriptions, supply shortages, and all kinds of other abuses, and pharmacy crawls going on… Most if those patients aren’t trying to fill prescriptions of 30 mg. Oxycodone tablets, for an acute knee “smash” by a gun!, and non-opioid tolerant? Something about this particular story, patient, and doctor DOES raise a few “red flags”, when MOST chronic pain patients are opioid tolerant, have very legitimate, diagnosed pain conditions, see the same doctor every month, etc…. and don’t have quite the same level of DRAMA as this story does! Sorry, but I just had to say it, because I know others will be thinking it when they read this!

    This guy may have had tremendous pain, been profiled and MIS-judged by his appearance, had to do a ridiculous amount of traveling, had a legit RX, and suffered without pain relief (ALL UNFAIR). HOWEVER, most of those doing the pharmacy crawls, suffering from severe chronic pain conditions, etc… Will go into AGONIZING (& possibly life threatening) WITHDRAWAL without their medication! THOSE people MIGHT actually pay the
    thousands of dollars, and go into bankruptcy because of their desperation, PAIN, and to AVOID horrendous withdrawal. Some of them know the pharmacists, have been seeing them for years, have reputable, known, local doctors, and are being turned away and price gouged. I think this are the people the gougers are counting on!

    Regardless….. to abuse a population of people who are already suffering, in pain, vulnerable, and desperate is a complete disgrace. What is happening to chronic pain patients all over this country is cruel and the equivalent of TORTURE. From the DEA, Federal & State governments, insurance companies (BCBS of MA- July 1,2012), physician groups (PROP), the doctors who take an oath to not harm, and Pharmacists who we rely on and trust….many of them, aiming their fear, judgement, misunderstanding, and anger at the VERY people who need them the most. Living life with severe chronic pain is TOLERABLE when there is some reliable relief in opioid therapy. To take that, for many of us with chronic, intractable pain, the ONLY treatment that allows for some semblance of a life, AWAY, or to bankrupt us in order to get it, should be punishable by law. What do we do? Call the police?…. NO ONE is listening, and telling our stories, the truth of what is happening in our lives. EXCEPT…. YOU! ….and a few other brave souls are TELLING the REAL stories. PLEASE KEEP TELLING THEM, until someone who can DO SOMETHING, actually listens. THank you, Mark!

  10. The problem with the first story is somewhat why people with chronic moderate to severe pain can not get their medication. This guy got hs knee busted. Why is he being put on a medication for moderate to severe long term use? What about ultram or another medication that should be used to treat this type pain? Not that he should have been treated this way by pharmacists, but I believe he was prescribed too strong a medication for the injury. This med is not for an acute injury.